David L. Squires Foundation Scholarship Application

• Transcript of marks for the two most recent academic semesters completed.
• Proof of registration in applicable courses.
• Two personal references.

A. Academic Program Information:

Institution Name:
Degree/Program Name:
Duration of this program (Years):
Year of program you are currently in:
Year you expect to graduate:

What is your grade point average for your last 2 completed semesters/terms expressed as a percentage out of 100?

Semester #1  60616263646566676869707172737475767778798081828384858687888990919293949596979899100 %  Semester #2  60616263646566676869707172737475767778798081828384858687888990919293949596979899100 %

B. Financial Information:

Who are the prime sources of your financial support? Select all that apply.

Self   Spouse  Parent/Guardian

C. Employment:

Are you currently employed?

Full-time   Part-time   Not-employed

D. Awards and Scholarships:

Have you or will you receive any other Awards or Scholarships this calendar year?

Yes   No

E. Student Loans:

Have you or will you receive any Student Loans this calendar year?

Yes   No

Jan.1 to Dec.31 – Current Year $
Total:

F. Actual or Anticipated Expenses:

Jan.1 to Dec.31 – Current Year $
Tuition Fees:
Books
Room/Rent
Transportation

G. Other Academic Expenses:

Please describe any other academic expenses and that you will incur for the calendar year.
For example: computer hardware and/or software.

H. Additional Information:

Please provide any further information that will assist in clarifying your financial
situation. Please identify other sources of funding not covered above. Specifically,
if your anticipated expenses exceed your anticipated income for the school year
please indicate how you intend to deal with any shortfall.

I. Affirmation:

(Please read carefully)
I, the applicant, do solemnly affirm that the information I have given in support of my application is, to the best of my knowledge and belief, true, accurate and complete, and I authorize the David L. Squires Foundation to verify any or all of the information provided. I further acknowledge that I may be disqualified from the competition for knowingly providing false or misleading information in this application. I agree that if I win this scholarship, the David L. Squires Foundation may use my name and photograph for publicity purposes.

  I agree to all the terms.

By submitting this form to the committee, you are providing a virtual signature attesting to that all information is true.
The short listed candidates will be asked to sign.

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