Wallace F. Smith Memorial Scholarship Application

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Wallace F. Smith Memorial Scholarship Application

Each year the Maryland Classified Employees Association, Inc. awards its Wallace F. Smith Memorial

Scholarship to individuals seeking admission to, or attending, an accredited school of higher learning who

have a financial need, have set high goals, and have attained scholastic achievement.  MCEA’s Wallace F.

Smith Memorial Scholarship Committee will award a scholarship to one individual representing each of the Association’s five geographical areas.

 

Qualifications for applying for the 2013 Wallace F. Smith Memorial Scholarship

 

A.       Must be a member of the Maryland Classified Employees Association, or a spouse or legal

dependent of an MCEA member.

B.      Must be seeking a college education beyond the high school level.

C.      Must meet the eligibility requirements for the school of his/her choice.

D.      Must be seeking admission to, or attending, an accredited community college, four year college or university, or other accredited institution of higher learning.

E.       Must be a citizen of the United States of America.

F.       Must not have received an award within the last two years from MCEA.

APPLICANT TO BE JUDGED ON THE FOLLOWING CRITERIA:

A.       Scholastic Achievement   B.  Financial Need   C. Goals    D. Essay   E. References

Attach Copies Of The Following:

1.        Proof of acceptance from college or university.

2.       Transcript of grades (high school and/or college).

3.       Non-returnable, current photograph.

4.       Two (2) letters of reference from non-family members.

5.       A typed essay stating why you feel you should be awarded this scholarship.

UPON COMPLETION, FORWARD APPLICATION BY JULY 31, 2013 TO:

Maryland Classified Employees Association, Inc.

Wallace F. Smith Memorial Scholarship Committee

7127 Rutherford Road

Baltimore, Maryland  21244-2763

(410) 298-8800 *** 1-888-611-MCEA (6232)

 

Mark on the envelope:  “Personal – (Wallace F. Smith) Memorial Scholarship Committee only”

 

Please review the guidelines before completing this application and print or type all applicable sections. 

In sections that are not applicable, please mark, “N/A.”

 

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED.

 

 


 

 

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Section A: Information about applicant. (Must be completed by all applicants.)

 

1. Name of applicant:                                                                                                                                                                    

2. Social Security Number: _____ _____ _____ - _____ _____ - _____ _____ _____ _____

3. MCEA chapter no. : _________________ Area: ______________ (if applicable)

4. Permanent address: ____________________________ City/State_________________ Zip_________

5. Telephone Number: Home: _____-_______-_______Work: ________-___________-____________

6. Date of birth: _____/_____/_____

7. State of legal residence: _______________________________

8. Are you a citizen of the United States of America? YES ______ NO ______

9. Occupation:                                                                                       Title:                                                                                 

10. Agency/Employer:                                                                                                                                                                  

       Address: __________________________ City/State: _______________________ Zip____________

Telephone no.: ( ) __________________________

11. Number of years employed at current place of employment:                                                                                             

12. Annual income from salaries, wages, tips, outside income, alimony, child support $________________

13. Marital status: _____________________ 14. Number ages of dependents:_________________________

15. Name and location of last school attended:                                                                                                                                 

                                                                                                                                                                                                                               

16. Circle the highest grade completed:       1  2  3  4  5  6  7  8  9  10  11  12

17. Did you graduate from high school?  YES _______ NO _______

18. If you did not graduate from high school, have you passed examinations and received a high school equivalency certificate from the State of Maryland or any other state? YES _______ NO _______

If YES, give name of state: _____________________________________ Year awarded: ___________________

19. List name and location of any college or university which you have attended or are now attending:

        Name                                                         Location                                                       Dates attended

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20. If the applicant has received a degree, give type of degree and date received:                                                                                                                                                                                                                                                                                           

21. If the applicant has not received a degree, give number of credit hours completed:                                                 

 

 

 

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Section B: Information (Member only)                                                                                

1. Name of member:                                                                                                                                                                     

2. Social Security number: _____ _____ _____ - _____ _____ - _____ _____ _____ _____

3. MCEA chapter number: _________________ Area: ______________

4. Permanent address: __________________________________ City/State_________________ Zip________

5. Telephone number:  Home: ________-________-________ Work: _________-___________-__________

6. Date of birth: _____ / _____ / _____ 7. State of legal residence: _______________________________

8. Are you a citizen of the United States? YES ______ NO ______

9. Occupation: _______________________________

10. Agency/Employer: ___________________________________________________________________

Address: _____________________________________ City/State: _______________________Zip___________

Telephone number: ____________-_______________-_____________________________

11. Number of years employed at current place of employment: ______________________

12. Annual income from salaries, wages, tips, outside income, alimony, child support, etc. $                        

13. Marital status: _____________________ 14. Number and ages of dependents: _________________

15. Relationship to applicant__________________________

Section C: Information about applicant’s spouse, parent, or legal guardian

Indicate whether this financial information applies to the applicant's:

ð        Spouse

ð        Parent

ð        Legal guardian

If the member is a parent of the applicant, and another parent resides in the household and/or provides the applicant financial support, you must complete this section for the second parent.

1. Name: __________________________________________________________________________

2. Address: ________________________________________________________________________

City/State: _______________________________________________________________________

Telephone number:___________-_____________-_____________

4. Marital status: ________________________________

5. Occupation:______________________________________________________________________

6. Agency/Employer: _________________________________________________________________

Address: ________________________________________________________________________

City/State: _______________________________________________________________________

Telephone number: __________-__________-______________________

7. Number of years at current place of employment __________________________________________

8. Annual income from salaries, wages, tips, outside income, alimony, child support, etc. $__________

9. Number and ages of dependents: ________________________________________________________


 

 

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Section C:  Information about applicant’s spouse, parent, or legal guardian

10. During the past year, has your household experienced any unusual medical expenses, losses, etc. that were not covered by insurances?  YES ____    NO____

 

If YES, please explain here:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         

 

11. Is applicant receiving any other financial aid? YES _____ NO _____   If YES, list source and amount:

Source:                                                                                                                                                 Amount:

_____________________________________                                    $__________________________

_____________________________________                                    $__________________________

_____________________________________                                    $__________________________

_____________________________________                                    $__________________________

_____________________________________                                    $__________________________

 

Total: $__________________________

 

Applications not postmarked by JULY 31, 2013 or not completed will not be considered for a scholarship.  I hereby affirm that this application contains no willful misrepresentations or falsifications, and that this information given by me is true and complete to the best of my knowledge and belief.

 

                                                                                                                                                                                                                               

Signature of applicant Date

 

                                                                                                                                                                                                                               

Signature of MCEA member Date

 

 

 

5/31/13 (revised)