THE DARIEN
COMMUNITY ASSOCIATION, INC.
(203) 655-9050
2010
Application for
CONTINUING STUDENT
AID SCHOLARSHIP
Today's Date ____________
This application must be returned to The
by Wednesday, May 19, 2010 either by mail or fax 203-655-4009.
DCA Student Aid Scholarships are
awarded annually to former students of
Note: It is essential that you attach the first page
of your parent(s) tax return.
Name: _______________________________________________________
Address: ___________________________________________(owned
or rented)
Telephone:
______________________E-mail:_____________________________
Name & Address of College: _____________________________________
_____________________________________
_____________________________________
College Status in Forthcoming Year:
Freshman ______ Sophomore _______ Junior _______
Senior _______
On one page (use
back of application), please give your reasons for desiring to continue your
educations. Include: 1) any remarks which might influence your
receiving a DCA Scholarship and
2) your future
plans and aspirations.
Student's Signature:
_________________________________________________
Parent's
Signature:
__________________________________________________
Date:
_______________________
2010 DCA Continuing Student Aid Scholarship
Application Page 2 of 3
Section l. College/Financial
Information
Expenses of
College you plan to attend:
a. Tuition and fees $_______________________
b. Room and Board _______________________
c. Other expenses, (i.e. books, supplies,
travel) _______________________
Total Expenses $_______________________
How do you plan to
pay for these expenses?
a. Parent
Contribution:
1.
College Scholarship Service estimate of
parents contribution $_______________________
2. Amount parents able to contribute $_______________________
b. Your
contribution:
1.
Amount already saved $_______________________
2.
Earnings this summer (estimate) $_______________________
3.
Anticipated earnings during school year
(not part of financial aid package) $_______________________
c. Amount
of aid for which you have applied: Check
if received
1.
Grant/scholarship from college $_______________________ _____________
2.
Government Loans $_______________________ _____________
3.
Bank Loan $_______________________ _____________
4.
Work Aid $_______________________ _____________
d. Local
scholarships awarded (community
organizations, corporations, churches,
etc.) $_______________________ _____________
e. Other sources of income (aid from
relatives, etc.) $_______________________
Total income $_______________________
Amount needed from other sources $_______________________
(Subtract total income from total
expenses)
List your total
Loans outstanding to date. $_______________________
What other
scholarships have you applied for?
What is the policy of your college
concerning the amount of scholarship aid you can receive from outside sources
without the college reducing its contribution to your aid package? This question must be answered before we can consider you for a scholarship.
2010 DCA Continuing Student Aid Scholarship Application Page 3 of 3
Section II. College Information
1. What is your grade point average? Current Year ________ Cumulative ________
2. Please list your extracurricular
activities and offices held.
Section III. Family Information
1. Family Status: Married ______ Divorced _______
Deceased Mother _______ Deceased
Father ______
2. List all children in your family.
Name Age School & Grade Year or Place of
Employment
__________________________ ________
________________________
________________________
__________________________ ________
________________________
________________________
__________________________ ________
________________________
________________________
3. Please provide the following
information:
Occupation Employer
Annual Income
Father ____________________________ __________________________________ ___________________
Step-father (if
applicable)
____________________________ __________________________________ ___________________
Mother
____________________________
__________________________________
___________________
Step-mother (if
applicable)
____________________________ __________________________________ ___________________
4. Please explain any extraordinary expenses
facing your family which affect your ability to finance your education.
5. How do you contribute to your own support
at this time?
Please use reverse side for your essay. See front page for description. Rev. 3/10/10