AMVETS POST 1776
549 Merchant Street
Vacaville, CA  95688
707-447-6354

SCHOLARSHIP APPLICATION FOR 2019

Name: 		_______________________________________________________________
		(Last)				(First) 			(Middle) 

Address: 	_________________________________________CA____________________
		(St # name)			(City)		      		(Zip code)

Date of birth: ___________	Place of birth _______________________ Sex _______

High School(s) attended (dates of attendance and expected graduation) _________________
___________________________________________________________________________

College or university you expect to attend: _________________________________________

School activities: (attach a separate sheet if necessary):______________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Community activities:__________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Honors or awards received in High school:_________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________
  
Employment within the last three years: ___________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Name of parents or legal guardian: ______________________________________________

Address: ___________________________________________________________________

I certified that the above information is correct:     ___________________________________
								  (Students’ signature) 

PARENTS/GUARDIAN CONFIDENTIAL STATEMENT  

Student’s name: _____________________________________________________________
			(Last) 				(First)  			(Middle) 

Check those that apply:

(      ) Father is deceased				(      ) Parents are separated or divorced
(      ) Mother is deceased				(      ) Other special circumstances 
(      ) Parents are disabled and unable to work	          (Explain on the reverse side)	

Father, stepfather or legal guardian:

Name _________________________		Address___________________________

Occupation______________________		Employed by:_______________________

Years with employer: _____				

Have you ever been in the armed forces?    (     ) Yes   (    ) No

If so, what branch of service: _________________		Number of years: _________

Date of enlistment:____________ Date of discharge___________ Highest rank: ________

Discharge type: (     ) Honorable          (     ) General             (     ) undesirable
		  (      ) Bad conduct      (      ) Dishonorable 

PLEASE ATTACH A COPY OF YOUR DD-214 (DISCHARGE DOCUMENT)

Mother, stepmother or legal guardian:

Name _________________________		Address___________________________

Occupation______________________		Employed by:_______________________

Years with employer: _____				

Have you ever been in the armed forces?    (     ) Yes   (    ) No

If so, what branch of service: _________________		Number of years: _________

Date of enlistment:__________ Date of discharge___________ Highest rank: _________

Discharge type: (     ) Honorable          (     ) General             (     ) undesirable
		  (      ) Bad conduct      (      ) Dishonorable 

PLEASE ATTACH A COPY OF YOUR DD-214 (DISCHARGE DOCUMENT)

PARENTS CONFIDENTIAL STATEMENT CONTINUED 

What is the number of dependent children living in the household and what are their ages?
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Are either parents members of a veteran’s organization?  Check those that apply

(      )   American Legion   		(      ) Disabled American Veterans
(      )   Veterans of Foreign Wars	(      ) Brotherhood of Vietnam Veterans
(      )   AMVETS			(      ) United Veterans Memorial Association
(      )   Any veterans Auxiliary	(      ) Other veteran group (please specify)
					          _______________________________

We declare that the above information on this form is true and correct to the best of your knowledge and belief.  

______________________________________
   (Signature of parent or legal guardian) 

	

STUDENTS STATEMENT

In the space provided here or on a separate sheet of paper, please write a short autobiography and include a discussion of your interests, hobbies, special skills, church or social activities, and any other information you feel will help us choose you as a applicant for the scholarship.  In addition, tell us your educational goals, career plans, and how you expect further education to prepare you for life’s challenges.  (Please attach a copy of your high school transcript)

DESCRIPTION OF SCHOLARSHIP

AMVETS POST 1776 
Vacaville, CA

There shall be three scholarships awarded for $250 to Vanden High, Vacaville High, Will C Wood, Buckingham Charter and Vacaville Christian High.  Applicants shall be graduating seniors.  The applicant must be of high moral character, possess a 3.0 GPA or better and demonstrate a need for monetary assistance in attending any accredited college or specialized school.  First preference is given to dependents of veterans.  Incomplete applications or applications received after the date below will not be considered. All applications must be received by Monday 15 April 2019.

PLEASE MAIL COMPLETED APPLICATIONS TO: 

AMVETS POST 1776
c/o Lewis Derfuss
549 Merchant Street
Vacaville, CA 95688

OR

Call 707 592-9040 if you have any questions

Completed applications in a sealed and addressed envelope may also be hand delivered and dropped in Vet’s Hall delivery mail box (Not the “Flag Drop” Mail Box) by the front door at 549 Merchant Street.