CHICOPEE SAVINGS BANK CHARITABLE FOUNDATION 2017 SCHOLARSHIP APPLICATION
CSB Foundation Scholarship – West Springfield High School
ELIGIBILITY
Applicant must be a graduating senior at West Springfield High School.
Applicant must be a current resident of West Springfield.
Applicant must be entering into a degree program upon graduation to an accredited college or technical school.
Application must be completed in full, and School Transcripts must be attached to the application.
Application must be signed by a parent or guardian and the principal or guidance counselor.
Chicopee Savings Bank Charitable Foundation Board of Directors, employees and/or family members are ineligible.
STUDENTS AVAILABILITY OF APPLICATIONS & SUBMITTING YOUR APPLICATION
Applications are available from participating high school guidance departments or admissions departments. Applications cannot be obtained through the Chicopee Savings Bank Charitable Foundation.
Applicants must submit their applications to their school scholarship coordinator by May 15, 2017. The Chicopee Savings Bank Charitable Foundation will not accept applications submitted directly by the student.
SCHOLARSHIP COORDINATORS AND GUIDANCE COUNSELORS
Chicopee Savings Bank Charitable Foundation will accept up to five (5) applications for consideration from each school.
Chicopee Savings Bank Charitable Foundation requires that the Coordinator submit all applications for their school in one mailing to the attention of the Teri Szlosek, Chicopee Savings Bank Charitable Foundation, c/o Westfield Bank, 141 Elm Street, Westfield, MA 01085
DEADLINE: Applications must be received by the Chicopee Savings Bank Charitable Foundation prior to the close of business, Wednesday, May 24, 2017.
CSB Foundation Scholarship – West Springfield High School
2017 FOUNDATION SCHOLARSHIP APPLICATION _____________________________________________ Name _____________________________________________ Street, City, State, ZIP _____________________________________________ Home Telephone or Cell phone _____________________________________________ Signature of Principal/Guidance Counselor _____________________________________________ Signature of Parent(s) _____________________________________________ Signature of Student
_________________________________________________ Name of High School _________________________________________________ Cumulative Class Ranking / G.P.A. _________________________________________________ _________________________________________________ Colleges/Technical Schools Applied To _____________________________________________
Email: ______________________________________
Have you applied for other Scholarships? ______________ Where? _________________________________________ _________________________________________________
Have you been accepted? Yes/No (if accepted, please include College Student ID #, or last 4 # SS, college address attending): ____________________________________________
Family Information (Please Print) _________________________________________________ Father’s Name and Occupation _________________________________________________ Mother’s Name and Occupation Do you live with both parents: Yes____ No____ Number of Dependent Children: _____________
CSB Foundation Scholarship – West Springfield High School
Income:
<=$50,000
$50,000 - $75,000
>$100,000
Income:
<=$50,000
$50,000 - $75,000
>$100,000
Number of dependent children in college next year: ________ __________________________________ .
P l e a s e P r o v i d e t h e F o l l o wi n g A d d i t i o n a l I n f o r m a t i o n School Activities (List personal awards and/or achievements)
Extracurricular Activities (List personal awards and/or achievements)
Community Activities (List youth groups, fellowships, etc. I.E.: J.A., 4H Club and any positions held)
Hobbies & Personal Interests (Explain briefly, in your personal resume, how you became interested and why)
Why do you feel that you deserve this scholarship? (Please include any special circumstances.)
CSB Foundation Scholarship – West Springfield High School
Personal Resume (Please use reverse side if necessary)
PLEASE SIGN THE FOLLOWING STATEMENT: All the information I have provided is accurate. I hereby give the Chicopee Savings Bank Charitable Foundation permission to contact my school or my references to provide additional information or to attest to any of the information contained herein. If I am a scholarship recipient, I grant permission to Chicopee Savings Bank Charitable Foundation to use my name and photo in a press release.
___________________________________________ Signature of Applicant
_______________________ Date
APPLICATION MUST BE SUBMITTED TO YOUR SCHOOL COORDINATOR ON OR BEFORE MAY 15, 2017. APPLICATIONS WILL ONLY BE ACCEPTED BY CHICOPEE SAVINGS BANK CHARITABLE FOUNDATION FROM THE SCHOOL COORDINATOR ON OR BEFORE MAY 24, 2017.
School Counselor/Coordinator – COMMENTS:
CSB Foundation Scholarship – West Springfield High School
