Print Form RETURN THIS APPLICATION TO THE GUIDANCE OFFICE BY MAY 5, 2017. YOU MUST FILE A FAFSA AND CSS PROFILE, AND BRING US A COPY OF YOUR COLLEGE'S FINANCIAL AID AWARD LETTER (OR DENIAL OF AID) TO QUALIFY FOR LOCAL AID AS SOON AS YOU RECEIVE IT.

APPLICATION (High School Senior) NEW CANAAN HIGH SCHOOL SCHOLARSHIP FOUNDATION School Counseling Department New Canaan High School School Code #7929 Personal E-mail:

I. Personal Data:

Please do not use your NCPS E-Mail Address

Cell

Home Phone

1. Name 2. Address

Social Security #

3. Father's/Guardian's Name and Occupation: 4. Mother's/Guardian's Name and Occupation: 5. Other Family Members Living in Same Household: Name

II.

Relationship

Age

Indicate if he/she is employed full-time or is a college student

Post-Secondary Data:

1. Colleges to which you are applying: 2. Anticipated major: 3.

Year of graduation from NCHS:

III.

Scholarship Plans: Other scholarships, grants, and loans you are seeking or have been awarded. Source

1. 2. 3.

Amt. Sought or Received

Date Filed

Granted

Pending

1. At this point in your education, what are your career goals?

2. Please state any unusual circumstances that may have an impact on your financial status for the committee's evaluation. (Continue on separate sheet if necessary.)

3. Please fill out the Student Activity Sheet that is attached at the end of this application. 4.Specific Activities: Check the specific activities below in which you have participated at any time during K-12: •New Canaan Boys' Baseball •New Canaan Lacrosse Association •New Canaan Soccer Association •New Canaan High School Sports •Youth in Government •Pop Warner Football •Plan to major in, or have interest in U.S. History Explain: •Plan to major in, or have interest in art of music Explain:

IMPORTANT!!! I verify that I have submitted a Free Application for Federal Student Aid (FAFSA) and a PROFILE form to the College Scholarship Service on (fill in date), requesting in item #4 of the PROFILE registration that information be sent to NCHS Scholarship Foundation, CSS Code # 7929.

Signature

Date

THIS APPLICATION CANNOT BE CONSIDERED UNTIL YOU SUBMIT A COPY OF YOUR COLLEGE'S FINANCIAL AID AWARD LETTER (OR NOTICE OF NO AID).

STUDENT ACTIVITY FORM Name: Extracurricular Activities (grades 9-12). Please list your major extracurricular (student government, sports, musical activities, clubs, etc. ) and volunteer activities in the order of their importance to you. Be sure to include grade 12. Activity

Grade Level(s)

Approximate time spent Approximate time spent Hours per week Weeks per year

Do you plan to participate in college?

Positions Held

Work/Volunteer Experience Please list any paying position you have held in the past three years, starting with the most recent. Specific nature of work

Employer

Approximate dates of employment

Approximate number of hours spent per week

Summer Experience Please list your summer experience(s) in grades 9-12, starting with this past summer. Describe Experience

Location

Date

Hours Per Week

If the charts above do not provide you with the opportunity to inform us about your time outside of school, please write a paragraph or two that outlines your activities.