2018 Scholarship Application West Springfield High School The Chicopee Savings Bank Charitable Foundation is pleased to invite West Springfield High School to participate in its annual scholarship awards program. One applicant will be selected to receive a $3,000 scholarship award.

Eligibility Requirements Residency:

All applicants must be a graduating senior as of the class of 2018 from West Springfield High School and a resident of West Springfield, Massachusetts.

Academics:

All applicants must have a minimum 3.0 GPA and must demonstrate a strong academic standing and financial need. Additionally, volunteer performance in the community, participation in school activities, athletics and other activities are taken into consideration. Please be descriptive in your application.

College:

All applicants must be entering into a degree program at an accredited college, university or technical school in the summer or fall of 2018. Applicants may be full-time or part-time students with a minimum of 6 credit hours per semester.

Application Availability and Submission Requirements Availability: Application Components:

Student Submission:

School Submission:

Applications are provided to participating high school guidance departments and cannot be directly obtained through the Chicopee Savings Bank Charitable Foundation. (1) A completed 2018 Scholarship Application containing the signatures of the student, the student’s parent and/or guardian, and Guidance Department; (2) an official copy of the student’s high school transcript; and (3) Two signed letters of recommendation. All applicants must submit their completed and signed application to their High School Guidance Department Scholarship Coordinator on or before April 6, 2018. The Scholarship Committee will not accept applications received directly from the applicant. The Chicopee Savings Bank Charitable Foundation requires the Guidance Department Scholarship Coordinator to submit a maximum of five (5) applications, in one mailing, to the Foundation on or before April 16, 2018. If more than five applications are received, the school coordinator will be contacted and asked to eliminate applications until a maximum of five remain. Guidance Departments please forward completed applications to the attention of Teri Szlosek, Foundation Secretary at the following address: Chicopee Savings Bank Charitable Foundation c/o Westfield Bank 141 Elm Street, Westfield MA 01085

Scholarship Announcements and Awards 

The selected applicant and guidance department will be contacted via email by the Foundation Secretary on May 17, 2018.

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Awards will be paid directly to the applicant’s college in August. Prior to payment the applicant must provide the Foundation with their College ID and payment address.

2018 Scholarship Application Student L astN am e

First

M .I.

S treetAddress

Date

Apartm ent/U nit#

City

S tate

Zip

P hone

ApplicantE-m ailAddress

High School HighS chool From

CourseofS tudy: To

P reviousHighS chool From

Class R anking/GP A

Did you graduate? ___YES ___N O CourseofS tudy:

To

College W hatcollegedoyou anticipateentering?

___ FullT im e ___ P artT im e

# ofCredits:

(pleasecheckone) Anticipated DateofCollegeGraduation:

Declared M ajor/CourseofS tudy: CareerGoal:(P leasebedescriptive.)

Haveyou beenaccepted?: (P leasecheckone)

___ Yes___ N o

CollegeID #: CollegeN am e: CollegeP aym entAddress:

L istP lanned CollegeCam pusActivities:

Financial Need W hoisresponsibleforyourcollegeexpenses?

___ M yself ___ P arent(s) ___ Guardian(s)

AnnualIncom e: $ Com bined AnnualIncom e: $ Com bined AnnualIncom e: $

P arent(s)and/orGuardian(s):How m any dependentchildrenareyou currently payingtheircollegeexpense? Applicant: Doyou currently haveany childrenforw hichyou arefinancially responsible? P age1 of2

School and Extracurricular Activities T ellusaboutyourschooland extracurricularactivities.T heseincludeacadem icassociations,leadershipservices,clubs,athletics,band,chorus,etc.Includepositions held. W hathaveyou gained orlearned from theseservices? U seaseparatepieceofpaperifnecessary.

Community Volunteer Activities T ellusaboutyourcom m unity volunteeractivitiesandincludelengthofserviceorstartandenddatesasw ellasabriefdescriptionofyourinvolvem ent.W hatinspired you tovolunteerand w hathaveyou gained orlearned from yourcom m unity experiences? U seaseparatepieceofpaperifnecessary.

Employment T ellusaboutany payingjobsoy haveheld w hilein highschool.P leaseidentify w hetheryou held thesejobsduringtheschoolyearorassum m erjobs.

Letters of Recommendation P lease attached tw o (2)lettersofrecom m endation.O ne ofthe lettersm ust be from ateacherand orguidance counselorand the otherrepresentative ofyour academ icand/orcom m unity serviceactivities. Inaddition,they m ustbefrom anon-fam ily m em ber.

Signatures U ponsubm issionofthisapplication,Ihereby authorizetheChicopeeS avingsBankCharitableFoundationtoreview copiesofm y highschooltranscriptsforpurposes ofacadem icevaluation.Ihereby statethatallinform ation given isaccurate,com plete,and true.Iunderstand thatshould Ifailtoattend Collegein theS um m er/Fall of2018,orfailtoregisterforthenum berofcreditsanticipated,m y aw ard w illberescinded.Ihereby grantChicopeeS avingsBankCharitableFoundationperm ission tousem y nam eand/orlikeness,ifchosenasascholarshipaw ard w inner,forpublicity purposes. Applicants Signature: _____________________________________________________

______________________________________Date

Parent/Guardian Signature: ________________________________________________

______________________________________Date

Guidance Dept. Signature: _________________________________________________

______________________________________Date

APPLICANT CHECKLIST:  Ihavem ettheresidency requirem ent  Ihavem ettheacadem icrequirem ent.  T ranscriptsprovided w ithapplication.  Ihavestated m y careergoals.  Ihavecom pleted thefinancialneed section.  P roofofm atriculation(i.e.:letterfrom registrar’soffice)provided w ithapplicationO R proofw illfollow .  Iam /w illbeam atriculated,undergraduatestudentatanaccreditedcollege,university ortechnicalschoolfortheS um m er/Fall2018 T erm .  L istofActivitiesand Com m unity S ervice  R ecom m endationL etter1  R ecom m endationL etter2  ApplicationS igned by: ____ Applicant; ____ P arent/Guardian; ____ GuidanceDepartm ent  ApplicationprovidedtoS choolGuidanceDepartm entS cholarshipCoordinatoronorbeforeApril6,2018 P age2of2