Name of Applicant:

Address:

Phone:

Grade Point Average:

ACT Composite Score:

Class Rank:

Date of Birth:

Total number of family members living at home:

Number of dependents in your parents' family, including yourself-

Number of children

Number presently attending college

GALENA EDUCATIONAL FOUNDATION SCHOLARSHIP	The Galena Educational Foundation shall determine eligibility of a graduating Galena High School senior	student and award a scholarship not to exceed $2,000.00, which shall be awarded up to $ 1,000.00 per semester. To	qualify, the student must attend an institution approved by the Foundation and be a full time student for two	consecutive semesters within the first two years following his or her graduation. Failure to use the funds within the	first two years following graduation or failure to comply with any other requirement shall result in forfeiture of the	remaining funds to the Foundation. The Foundation shall notify the student of any failure to meet qualifying criteria	and in that event the student has the right to appeal said decision within ten (I 0) days. The Foundation has absolute	discretion to determine any appeals and their decision shall be binding on all parties. All scholarship money will be	deposited directly with the ''qualified institution''. out of In the space provided, please indicate your family's adjusted gross income from last year's tax returns. Under $25,000 $35,000 to $40,000 $25,000 to $30,000 $40,000 to $50,000 $30,000 to $35,000 over $50,000 Ages: Other financial consideration which should be noted:

Signature:

Please list below any scholarship monies you have already been awarded. List only those that you know you are going to receive and their award amount. Scholarship Name Amount of Award Date: 1. List five things you like best about yourself and why. 2. List five things about yourself you want to improve and why. 3. List five things you like best about your country and the reasons why. 4. List five things you like least about your country and tell what you believe could be done to	improve them. 5. List five ways a college degree might have a positive effect on your life. 6. List five things about your personal life that likely would not be affected by a college degree. 7. How can Galena become a more desirable place in which to live? 8. What are your career goals and plans? Deadline to return this scholarship application to the school counselor is Friday, April 12, 2019.