Zonta Club of Melbourne Area

ZONTA/ MEEHANS’ SCHOLARSHIP APPLICATION

We are pleased to announce that the Zonta Club of the Melbourne Area is making available scholarships ranging from $50 - $1200. This program is designed to assist women living in Brevard County, who are returning to school or beginning school for the first time. To be eligible, applicant must either be enrolled as a part or full time student at an accredited college, university, or trade school, or plan to be enrolled when the next term begins.

All applications must be postmarked by November 1. Incomplete applications, and those postmarked after the deadline, will not be considered or returned. RECEIPT OF INDIVIDUAL APPLICATIONS WILL NOT BE ACKNOWLEDGED. Applicants may be asked for an interview with the Zonta scholarship committee. If selected, recipient will be notified by December 15. In accepting the scholarship, the recipient may be asked to attend at least one Zonta meeting, social, or event in the first year of scholarship. A check in the amount of scholarship winnings will be sent to the school, and be credited to recipient’s account upon endorsement by recipient and the school. Theses scholarships are renewable and can be reapplied for each year. Scholarships may also be awarded directly to individuals for incidental expenses, or fees required for the GED exam or other exams necessary for licensing in their field of work.

Name___________________________________________________________________

Street Address____________________________________________________________

City_______________________________________________ State______ Zip_______

Phone ( )____________________________E-mail address______________________

Date of Birth________________________ Social Security #______________________

Marital Status: Single ______ Married ______ Widowed ______ Divorced ______

Separated______

Do you have children? Yes ______ No______ Ages_________________________

Name of College, University, or Trade School __________________________________

Address ________________________________________________________________

Amount of scholarship you are requesting______________________

Are you currently enrolled in this institution? Yes_____ No ______

If no, please give date of expected enrollment and proceed below. __________________

If yes, please complete the following:

Field of Study____________________________________________________________

Part Time ______ Full Time ______

Number of credits required for completion _______________

Number of credits acquired toward this degree ______ Anticipated Graduation Date____

Are you a high school graduate or GED certified? Yes______ No______

Do you have previous college experience? Yes______ No______

If yes, give name of college, location, dates attended, course of study and degree obtained.

Are you a citizen of the U.S.? Yes ______ No _______ If no, please provide proof of legal residency.

Are you currently residing in Brevard County? Yes______ No ______

Are you currently employed? Yes ______ No ______Full Time______ Part Time ________

Name, address, and phone number of employer _________________________________

Is your employer providing educational funding? Yes ______ No______ If yes, how much? ______

Please give a brief work history covering the past two years. Include the name of the company, location, position held, length of employment, and reason for leaving. (if necessary, attach a separate sheet.)

________________________________________________________________________

ESSAY SECTION

(ATTACH A SEPARATE SHEET(S) WITH YOUR RESPONSE. PLEASE HAND PRINT OR TYPE.)

Zonta International is a worldwide service organization of over 35,000 executives in over 68 countries. Zontians give time, talent, and energy especially in the area of women’s development, health, education, and cultural needs. They encourage high ethical standards and work to improve the legal, political, economic, and professional status of women.

In 1000 words or less, please explain how your education can contribute to these goals by addressing a minimum of five of the following points:

What is your anticipated gross income for this year? ________________________________

If applicable how much does your spouse anticipate earning this year? _______________

Do you receive income from other sources (e.g. social security benefits, veteran benefits, child support, parental support)?

If yes, please list type and amount. _____________________________________

Do you have any dependents other than spouse and children living in your household? Yes ______ No _________

Are you financially responsible for children and other dependents living in your home?

Yes_______No__________

Please enclose signed copies of your IRS 1040 tax forms for the past two years. If you are a dependent included on your parents return, also enclose copies of those returns for the past two years.

CONTRACTUAL AGREEMENT

I, __________________________________________________________ hereby acknowledge that all of the information included in this application is true and complete to the best of my knowledge. If additional information or documentation is requested of me, I will be pleased to furnish it.

Signature________________________________________________ Date ______

If you are awarded a scholarship, you will be asked to provide the name and address of the college’s financial administrator/financial aid department.

ALL APPLICATIONS WILL BE HELD CONFIDENTIAL

UPON COMPLETION OF THIS APPLICATION, PLEASE MAIL WITH ATTACHMENTS AND TAX FORMS TO:

ZONTA CLUB OF MELBOURNE AREA

SCHOLARSHIP COMMITTEE

P.O. BOX 417

MELBOURNE, FL 32902-0417