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College School Application
Deadline for Application: April 8, 2024
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of
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Today's Date
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MM slash DD slash YYYY
Name
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First
Last
Age
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Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Additional Items
Essay should be 150 word minimum discussing any personal information that you would like to share with the Perry Hulton scholarship committee relevant to your educational goals, volunteer work, paid jobs, motivational factors that influenced your decisions, or obstacles you have/are facing.
Transcript (Unofficial)
*
Max. file size: 50 MB.
Essay
*
150-500 Words
Max. file size: 50 MB.
Picture
Max. file size: 50 MB.
What high school did you graduate from?
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Date of Graduation
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MM slash DD slash YYYY
List the colleges you’ve attended and the year(s) attended
*
Add
Remove
What is your cumulative grade point average?
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What college will you attend this coming fall?
*
Have you selected an area of major study?
*
No
Yes
If yes, what?
Have you been awarded a Phyllis Perry Hulton Scholarship before?
*
No
Yes
If yes, check year(s) received
2018/2019
2019/2020
2020/2021
2021/2022
2022/2023
2023/2024
Year not listed
Prior year received?
Do you plan to work for part of your expenses?
*
No
Yes
Do you have a physical disability?
*
No
Yes
If yes, please explain and state how it has affected your abilities as a student.
Family
Father's Name
First
Last
Phone
Employment
Address same as Student?
Yes
No
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Mother's Name
First
Last
Phone
Employment
Address same as Student?
Yes
No
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Stepmother's Name
First
Last
Phone
Employment
Address same as Student?
Yes
No
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Stepfather's Name
First
Last
Phone
Employment
Address same as Student?
Yes
No
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
If married, Spouse's Name
First
Last
Phone
Employment
Address same as Student?
Yes
No
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
References
List two adults as references (other than family member), preferably someone you have known for at least two years.
First Reference
*
First Name
Last Name
Phone
*
Relationship
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Second Reference
*
First Name
Last
Phone
*
Relationship
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Parents & Stepparent's Adjusted Gross Income in 2023 (Located on 2023 tax return)
*
Note: Please include Adjusted Gross Income on both parents tax return. If you haven’t filed your 2023 tax return please estimate or use Adjusted Gross Income from 2022.
If independent, please state your Adjusted Gross Income or you & your spouse in 2023
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Note: Independent means you are not a dependent on anyone else’s tax return and do not receive assistance for your education from a parent/guardian.
List student’s indebtedness in excess of $100
*
Include any other educational loans.
Money Owed To
Unpaid Balance
Purpose of Loan
Add
Remove
Please list names and ages of siblings or other persons dependent on your parents/guardians for financial support. If these are attending a college, university, technical or trade school, please write the names of the institutions.
*
Name
Age
Educational Institution
Add
Remove
Phyllis Perry Hulton Educational Trust Education Finance Planner
In Academic Year 2024 - 2025 I will be a
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Freshman
Sophomore
Junior
Senior
College/Technical School
*
Anticipated Costs for Academic School Year 2024-2025
1. Tuition and Registration Fees
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2. Books and Supplies
*
3. Room and Board
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4. Miscellaneous Living Expenses (Clothing, entertainment, etc.)
*
5. Medical
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6. Transportation (Travel)
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7. Other
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8. Total Estimated Expenses
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9. Money Parents, Stepparents Can Provide
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10. Money You Can Provide
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11. Other Scholarships
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Do not enter unless already awarded or student has a high probability of receiving one. Do not include Scholarship from Phyllis Perry Educational Trust.
12. Pell Grant
*
13. Guaranteed Student Loan
*
14. Total Lines 9-13
*
15. Amount needed for Academic School Year
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Subtract Line 14 from Line 8.
How you plan to cover the deficit?
*
FAFSA EFC information may be requested.
Applicant Signature
*
By typing your name in this space you agree and understand by typing your name it is a legal equivalent of your manual/handwritten signature
Full Name
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