Funding Document:

The following form is for Admirals Cove & Polo Club Scholars ONLY.

Please complete the following questionnaire. We will not process any request for funds unless all requested information is supplied.

Please select the appropriate statement:

This Semester.... *

First Name: *

Last Name: *

Email Address: *

Cell Phone: *

Home Phone:

Home Address: *

Address Line 2:

City: *

State/Province: *

Zip Code: *

School You Are Attending: *

Where do you plan to live during the school year? *

On Campus Housing
Off Campus Housing
Live With Parents

What is your best mailing address while in school?

Street Address *

Apartment, Suite, or Mailbox #: *

City *

State: *

Zip *

Are you employed while at school? *

Yes
No

If yes, provide name of employer and number of hours per week.

List any memberships in school or professional organizations.

List any honors or awards you have received since high school graduation.

List any other scholarship you have received (this will not affect your Snow Scholarship)

Has your family's financial situation changed since you have been awarded this scholarship? *

Yes
No

If yes, please explain.

Parents names and names of their employers. *

Major *

Current Cumulative Grade Point Average *

Total credited hours completed *

Current Status *

Freshman
Sophomore
Junior
Senior

Questions/Comments: Is there anything you would like to let the staff of The George Snow Scholarship Fund know?

Student ID # *

Year you received a George Snow Scholarship. *

Scholar's Affidavit

“Internal Revenue regulations require that your scholarship grant be used for qualified tuition and related expenses in order for it not to be taxable income to you. Qualified tuition and related expenses consist of tuition, fees, books, supplies, and equipment required for the courses of instruction at an educational organization. Examples of expenses that are not qualified tuition expenses are room and board and other general expenses. We suggest that you consult with a tax specialist to determine the tax consequences of your grant.”

I have read and understand the above statement and attest that these funds will be used accordingly. Failure to do so will result in forfeiture of any additional funds.

Date of Request *

I have read and agree to the above statement *

Timeout Warning

Funding Document:

Scholar's Affidavit