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2023 Chamber Foundation Scholarship Application
2023 Chamber Foundation Scholarship Application
*Applicant MUST live and/or study in the Dutchess County.
The deadline to submit application is April 15, 2023.
*IMPORTANT*
If you are a high school freshman, sophomore or junior, please immediately stop filling out the application as you are NOT eligible for any scholarships.
Applicant's Information:
First Name
*
Middle Name
*
Last Name
*
Date of Birth
*
Format: mm/dd/yyyy
Preferred Pronouns
Physical Address Line 1
*
Physical Address Line 2
City
*
State
*
Select option...
NY
Applicant MUST reside in NY
Zip Code
*
Mailing Address Line 1
Leave blank if the same as Physical Address
Mailing Address Line 2
Leave blank if the same as Physical Address
City
Leave blank if the same as Physical Address
State
Select option...
NY
Leave blank if the same as Physical Address
Zip Code
Leave blank if the same as Physical Address
County of Residence
*
Have you lived in the above County for at least 5 years?
*
Select option...
Yes
No
Daytime Phone
*
Email
*
__________________________________________________________
Family Information
Primary Parent/Guardian Information
First Name
*
Middle Name
*
Last Name
*
Job Title/Employment Status
*
Email
*
Daytime Phone
*
Parent/Guardian Marital Status
*
Select option...
Single
Married
Cohabitating
Separated
Divorced
Widowed
Other
Secondary Parent/Guardian Information
First Name
Middle Name
Last Name
Job Title/Employment Status
Email
Daytime Phone
Parent/Guardian Marital Status
Select option...
Single
Married
Cohabitating
Separated
Divorced
Widowed
Other
__________________________________________________________
How many siblings do you have?
*
Select option...
0
1
2
3
4
5
6
7
8
9
10+
If you do have siblings, how many are currently attending college?
*
Select option...
N/A 0
1
2
3
4
5
6
7
8
9
10+
__________________________________________________________
Current Education Level*
What is the last full year of education level you completed?
*
example: High School Senior, 1st year college, 2nd year college, etc.
GED*
Are you working on or have you achieved your GED or High School Diploma?
*
Select option...
GED/ High School Equivalency Diploma
High School Diploma
None
Are you currently enrolled in school?
*
Select option...
Yes
No
What is the name of the school you are currently enrolled in?
*
Date of High School Graduation/Diploma
Enter the date of your High School Graduation, High School Withdrawal, or completion of High School Equivalency Diploma
*
Format: M/d/yyyy
Have you been out of high school for 5 years or more?
*
Select option...
Yes
No
What is your class rank? (if available)
What is your class size? (if available)
What is your High School/GED/College Cumulative GPA?
*
What is your SAT total score? (if applicable)
What is your SAT Evidence- Based Reading & Writing score? (if applicable)
What is your SAT Math score? (if applicable)
What is your ACT Composite score? (if applicable)
__________________________________________________________
Higher Education
Do you CURRENTLY attend college as an undergraduate student?
*
Select option...
Yes
No
What college are you currently enrolled in?
What school(s) are you considering?
*
What is the name of the college/school for which scholarship aid is requested?
*
__________________________________________________________
College Major/Minor
What is your current or expected field of study?
*
What is the length of time to complete this course of study? (number of years)
*
Select option...
1 year
2 year
3 year
4 year
5 year
6 year plus
The type of school I plan to attend next year is _____
*
Select option...
a four- year college or university
a two- year college
a vocational or technical school
a graduate school
none of the above
I will be enrolled _____
*
Select option...
full time
half time or more
less than half time
I will live ______
*
Select option...
on campus
off campus
at home
Cost of Tuition for 1 year
*
Tuition only; do not include other expenses. If you are considering more than one school, enter the higher tuition cost.
__________________________________________________________
Financial Information
Should your scholarship be awarded, you will be required to provide the following documentation: Your Student Aid Report (SAR) and Expected Family Contribution (EFC) supporting documentation, which you will receive when you complete and submit your Free Application for Federal Student Aid (FAFSA). Please provide the most recent 2 Years of Tax Returns for yourself and/or a parent/guardian based on how you file.
Estimated Family Contribution (EFC)
*
Adjusted Gross Income (for yourself AND/OR your parent/guardian)
*
Taxable Income (for yourself AND/OR your parent/guardian)
*
Information may be found on Line 22 of IRS form 1040 or line 6 of IRS form 1040EZ. *If parents/guardians files separately, combine and enter the total for both here.
Describe any special personal, financial, emotional, physical, developmental or family obstacles which affect your financial resources that you would like the Committee to take into consideration in reviewing your application.
Examples: job changes, housing changes, family illness, caregiving, etc.
Additional Notes
Use this additional space to explain or elaborate on any of the previous questions that you would like to provide more information about to the Committee.
__________________________________________________________
SUPPORTING DOCUMENTATION
The supporting documents are required.
Accepted file formats: .doc; .docx; .odt; .pages; .pdf; .rtf; .txt; .wpd; .wps
Employment, Extracurricular Activities, and Volunteer Work
Have you been employed (paid work) within the last year? This includes being a baby sitter, life guard, cashier, landscaper, etc.
*
Select option...
Yes
No
Resume
Before uploading your resume, please be sure to include the following relevant information: Name or organization/Employer, title/position held (paid or unpaid) and responsibilities, the month and year started and ended (if no longer working there) and approximate hours per week, extracurricular activities, volunteer and community service work, awards and honors that you received.
Supporting Documentation - File 1: Applicant's Resume
*
UPLOAD HERE
Do you plan on being employed while studying for your degree?
*
Select option...
Yes
No
__________________________________________________________
Consent & Certification
If applicant is under the age of 18, a parent/guardian MUST give consent.
Student Certification
I, as the applicant, confirm that I am over the age of 18 and consent the release of my name and image(s) for any scholarship received to the media and for publication. I certify that the information on this form is true and complete to the best of my knowledge.
*
Select option...
I am over the age of 18 and I consent
I am under the age of 18 and cannot consent
Enter Applicants Full Name
*
By typing in your name, you confirm consent to the above.
Parent/Guardian Certification
If applicant is over the age of 18, and certified above, you may skip this confirmation.
I, as the Parent/Guardian, confirm that I am over the age of 18 and consent the release of my student's name and image(s) for any scholarship received to the media and for publication. I certify that the information on this form is true and complete to the best of my knowledge.
Select option...
I consent
Enter Parent/Guardian Full Name
Skip if not applicable. By typing in your name, you confirm consent to the above.
__________________________________________________________
Essays
Which scholarship(s) are you applying for? Check all that apply.
*
Cosimo DiBrizzi Culinary Arts Scholarship (General Essay)
Eileen Hickey Nursing Scholarship (General Essay)
Juan Lafuente Leadership Scholarship (General Essay)
Norman and Rita Nussbickel Memorial Scholarship (General Essay)
Richard W. Mitchell Memorial Scholarship (General Essay AND Overcoming Obstacles Essay)
General Essay
Required
Discuss your career goals, personal values and community services. The essay should not exceed 500 words. Please upload your separate word document here. * PLEASE NOTE: This essay will automatically be added to any application which uses a general essay. ESSAYS THAT DO NOT ADDRESS THE TOPIC WILL NOT BE CONSIDERED.
*
UPLOAD HERE
Overcoming Obstacles Essay *** To be completed for Richard W. Mitchell Memorial Scholarship ONLY
Describe how you overcame or are coping with obstacles in your life (personal, financial, emotional, family, educational, economic, physical, developmental, etc.) and your future aspirations. The essay should not exceed 500 words. Please upload your separate word document here. * PLEASE NOTE: This essay will automatically be added to any application which uses a general essay. ESSAYS THAT DO NOT ADDRESS THE TOPIC WILL NOT BE CONSIDERED.
UPLOAD HERE
__________________________________________________________
Transcripts/GED/High School Diploma
I accept that if I am to be awarded a scholarship, I will be asked to provide a copy of my transcript*/ GED/ High School Diploma.
*
I confirm
__________________________________________________________
Letters of Recommendations
You are required to provide 2 letters of recommendation. They may be from a teacher, coach, guidance counselor, employer, clergy or person other than a family member who is familiar with your skills and abilities.
Supporting Documentation - Letter of Recommendation 1
*
UPLOAD HERE
Supporting Documentation - Letter of Recommendation 2
*
UPLOAD HERE
-Before You Submit Your Application-
Before clicking 'Submit' below, please ensure you have thoroughly reviewed the information you provided, including personal information, resume, letters of recommendation, and essays.
