ATTENTION: Scholarship Committee
The Hannibal Area Chapter #4610 of the American Association of Retired Persons will award
two $500.00 scholarships this year. Since the majority of the members live in Hannibal area,
one of the scholarships will be awarded to an outstanding, graduating student form Hannibal
High School. The other scholarship will be awarded to an outstanding, graduating student from
Hannibal High School. The other scholarship will be awarded to an outstanding, graduating
student from the local area.
I am enclosing an application form, which may be reproduced. All applications must be
postmarked no later than April 1, 2012. Applications must be filled out completely and signed
by the applicant’s parent/guardian. Those not signed will be disqualified.
The members of AARP appreciate your help on this project.
All applications should be sent to:
Cc: Bowling Green High School
Canton School District R-5
Hannibal High School
Highland High School
Louisiana High School
Marion County R-2 School
Mark Twain High School
Monroe City High School
Palmyra High School
Bonnie Glendinning
312 W. North Street
Palmyra, MO 63461
704 West Adams, Bowling Green, MO 63334
200 S. 4th St., Canton, MO 63435
4500 McMasters Ave., Hannibal, Mo 63401
21504 State Highway 6, Ewing, MO 63440
3321 Georgia St., Louisiana 63353
2905 Highway D, Philadelphia, Mo. 63463
Highway 19, Center, Mo 63456
Highway 36 & 24, Monroe City, Mo 63456
South Main St., Palmyra, Mo 63461
HANNIBAL AREA CHAPTER OF AARP # 4610
SCHOLARSHIP OF EXCELLENCE
The AARP Scholarship of Excellence was established in 1991, to encourage
students to strive for excellence while in high school and to further their
education after completing high school.
CONDITIONS OF THE SCHOLARSHIP AWARD:
1. The one year scholarship will be in the amount of $500.00. $250.00 will be paid to the college
the first semester the student is enrolled in college. The final $250.00 will be paid the second
semester.
2. The recipient will be selected by a committee established by the Hannibal Area Chapter of AARP
#4610.
3. The recipient must be enrolled as a full time student in a fully accredited college or a vocational
(trade) school.
4. Payment will be made to the institution the student is attending upon receipt of notification of
enrollment and attendance, and a current address for the institution.
5. The scholarship may be used to obtain an education at a college, university, vocational, or a
trade school.
QUALIFICATIONS OF APPLICANT:
1. The student must be of the highest moral character.
2. The Recipient must be a graduating high school senior from an area school.
3. The applicant must have an academic record equivalent to a “C” or above
4. The applicant must show a reasonable need for financial assistance.
FORMAL APPLICATION MUST INCLUDE:
1. A completed Hannibal Area AARP #4610 Scholarship Application form, signed by the applicant
and parent or guardian.
2. A family Finical Statement
3. An Applicants Confidential School Record form completed an signed by an appropriate school
official
HANNIBAL CHAPTER AARP#4610
SCHOLARSHIP APPLICATION
I hereby make application for the Hannibal Chapter AARP #4610 Scholarship.
Name of Applicant
(last)
(first)
(middle)
Address of Applicant
Social Security Number
Telephone
I attend and plan to graduate from
I intend to enroll at
Father
Mother
(name of school)
(name of school)
(month/year)
for the term beginning
(month/year)
(name)
(occupation)
(name)
(occupation)
With whom do you live?
(name)
(relationship)
Name three persons, other than relatives, who know you and could be contacted to verify the
information on this application
Name
Address
Telephone
I certify that to the best of my knowledge, all information given is true and correct
__________________________
Signature of Applicant/ Date
________________________________
Signature of Parent-Guardian/Date
List the extra-curricular and community activities in which you have participated in while attending high
school. Include any special honors or awards received as well.
Activities
Honors
9th Grade
10th Grade
11th Grade
12th Grade
In the space below discuss your plans for the future including educational and career goals or areas that
are of interest to you (use back of sheet if needed)
Please list below all income available to meet expenses during term(s) financial aid is desired.
Personal Funds (cash, savings, etc.)………………………………………………….$
Private Loans…………………………………………………………………………………….$
Summer Earnings……………………………………………………………………………..$
Earnings While in School………………………………………………………………….$
Parental Support………………………………………………………………………………$
Scholarship (source):
………………………………………….$
Veteran’s Benefits……………………………………………………………………………$
Other Income…………………………………………………………………………………..$
Total Income (above)
$
College Expenses (one year)
$
Financial Need
$
Hannibal Chapter AARP #4610 Scholarship
Family Financial Statement
(Confidential)
One consideration for scholarship eligibility is family financial need as it relates to the student’s financial
ability to obtain further education.
Is anyone dependent upon you for support?
Yes ( )
No( )
If yes, name and relationship
Check the following items to indicate how you plan to pay expenses not covered by this scholarship.
Money furnished by the family (
) Earnings during summer (
)
Student employment (
)
Other means ( )
List below all members of your family dependent upon this income statement.
Name
Age
Grade in School
List additional names on the reverse of this form if neccessary
Income Information
Parents adjusted gross income as reported on the IRS Form 1040 or 1040A the previous years $
Family owned home
( ) Yes
( ) No
Special Circumstances: Please explain in the space provided below any unusual financial
circumstances which you think may be of interest to the committee.
Hannibal Chapter AARP #4610 Scholarship
Applicant’s Confidential School Record
(To be completed by appropriate school official)
Complete ALL requested information
School________________________________________________________________________
(name)
(address)
(city)
(state)
(zip)
Applicant’s Name _______________________________________________________________
(last)
(first)
(middle)
Address_______________________________________________________________________
(number & street)
(city)
(state)
(zip)
Date of birth___________________
Area Code & Telephone Number _______________
List all other secondary schools attended by this applicant and dates attended.
School
From (month/year)
To (month/year)
ACADEMIC STATISTICS (at seventh semester)
Grade point Average ___________________
Class Rank
___________________
Composite ACT
___________________
Number of Credits ___________________
College Prep/ Advanced Placement Courses:
______________________________________________________________________________
______________________________________________________________________________
Please rate the applicant by checking the appropriate boxes below:
Trait Rating
SUPERIOR
GOOD
AVERAGE
FAIR
POOR
INITITAIVE
CONCERN FOR
OTHERS
EMOTIONAL
STABILITY
IDUSTRY
APPERANCE
COOPERATION
(Date)
(Signature of Principal/Counselor)
(Title)