Scholarship Application

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Title

Applicant Name *

Home Address 1 *

Home Address 2

Zip / Post Code *

Applicant Email *

Applicant Cell Phone Number *

Parent Email Address *

Parent Phone Number *

GPA *

SAT/ACT

Tell us about the colleges you have applied to, listed in the order of preference:

Have you accepted an offer of admission? *

Yes
No

If so, at which college?

FINANCIAL INFORMATION

Tell us what you and your family can contribute towards the cost of College:

Please enter values as numbers and decimal only. (e.g. 1000.00)

Totals will be calculated automatically.

Your own earnings/savings

Parents contribution

Other Scholarships (specify)

Student Loans

Other sources (specify)

Total

If there is a funding gap between the total cost of your chosen college and the totals shown above, please describe your plans to offset this shortfall:

Parents Adjusted Gross Income

Parent's Profession/Employer

Parents Total Value of Cash & Investments

Parents Debt Obligations (including mortgage)

Students Adjusted Gross Income

Students Total Value of Cash & Investments

Please provide us with information about your siblings:

Please describe any extenuating financial circumstances that require you to seek financial aid: *

Please list any jobs you have held in the past two years:

Please tell us (1000 words or less) why the College Men’s Club should invest in you. *

Please upload your Common Application essay.

Upload File *

Please ensure the filename only contains numbers, letters, hyphens, or underscores.

Agreement to Terms

The College Men’s Club of Westfield provides scholarship funds directly to a matriculating student, NOT to the college they plan to attend. If I am selected for a scholarship, I hereby certify that the scholarship funds will ONLY be used to defray the cost of enrollment as a full time student at an accredited college or university. I understand that if I withdraw as a full time student, the scholarship may be revoked at the discretion of the College Men’s Club of Westfield.

I also understand that during the term of the scholarship, it will be my obligation to maintain a satisfactory grade average, and, at the request of the Scholarship Committee, to forward a transcript of my grades to them. I will also keep the Scholarship Committee informed about my scholastic accomplishments, progress and plans (including transfer, disenrollment, etc.)

I hereby grant permission for the release to the College Men’s Club of Westfield, the following confidential information, and will assist them in obtaining this information:

Westfield High School Transcript
Standardized Test Scores (ACT, SAT)
FAFSA Form
Common Application

I agree to all of the above terms *

Date *

Applicant Name *

Date *

Name of Parent or Guardian who approves this submission *

reCAPTCHA *

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About Us

Our Club backs Westfield men of all backgrounds. These young men need financial help and have demonstrated, by their actions and achievements, that our investment in them is likely to be repaid with success.