General Scholarship Application Form

1. Last Name ______________________ First Name _________________ Middle Initial ______
(from birth certificate)

2. Present Address ________________________________________________________________

3. City _________________________ State __________ Zip _____________

    Permanent Address (if different from above) _____________________________________

City _________________________ State __________ Zip _____________

4. Date of Birth ________________ Country of Birth ________ Citizenship __________________

5. Years of residence in U.S. ________    Social Security Number ______________________

6. Current employment _____________________________ Annual income ________________

7. Marital status ______________________ Number of children or dependents ___________

8. Spouse's name ___________________Occupation _________ Annual income __________

9. High Schools/Colleges Attended:Major/Field of Study

Institution Dates Attended (Month/Year)
Diploma		 Date
1. ____________________ ___________________ __________________ ___________________

2. ____________________

 ___________________ __________________ ___________________
3. ____________________ ___________________ __________________ ___________________
4. ____________________ ___________________ __________________ ___________________


10. College or Other Academic Scholarships to date:

Source Amount College Date
1. ____________________ ___________________ __________________ ___________________

2. ____________________

 ___________________ __________________ ___________________
3. ____________________ ___________________ __________________ ___________________
4. ____________________ ___________________ __________________ ___________________

 


11. Name and address of accredited college or university you are attending or will attend for graduate studies:

________________________________________________________________________________

________________________________________________________________________________

12. Current or Planned Major Field of Study _______________________________________

13. Anticipated Graduation Date __________________________________________________

                      
  

14. Expected Educational Costs:
Tuition and fees _____________________________
Housing _____________________________
Books and other academic materials _____________________________
Other (please specify) _____________________________
Total Educational Costs: _____________________________

 

15. Available Financial Resources:
Aid from parents/family _____________________________
Scholarships or gift aid _____________________________
Loans _____________________________
Employment Income _____________________________
Total Contribution: _____________________________







16. List undergraduate/graduate academic honors:

_____________________________________________________ Date Received ______________

_____________________________________________________ Date Received ______________

_____________________________________________________ Date Received ______________

_____________________________________________________ Date Received ______________






17. Membership in community or professional organizations:

_____________________________________________________ Date Received ______________

_____________________________________________________ Date Received ______________

_____________________________________________________ Date Received ______________

_____________________________________________________ Date Received ______________



18. List the names of the individuals that are providing reference/recommendation
letters for your scholarship:

Reference #1 _______________________________________ Relation _____________________

Reference #2 _______________________________________ Relation _____________________

Reference #3 _______________________________________ Relation _____________________





19. Attach a 2-3 page personal essay describing previous and future contributions to the Armenian community. Please include relevant background information on the programs to which you are applying, your specific goals/motivations for applying to these programs, and future plans inside and outside the Armenian community.




 

Signature _______________________________________________ Date ___________________

By signing this document I hearby declare that all of the information I have provided is correct and may be verified by CAKE/ChurchArmenia.com as true and factual.



Please mail this form with complete application materials to:

Charles and Agnes Kazarian Eternal Foundation/ChurchArmenia.com
30 Kennedy Plaza, 2nd floor
Providence, RI 02903
Attn: Educational Scholarships

Additional comments or questions
e-mail info@churcharmenia.com