Donna Adams Mahaffey & Jean DiLuzio Scholarship Applicant Information: Title First Name * Last Name * Suffix Current Age - If under 18, parent/guardian must complete consent form (below) * Parent/Guardian Name (if applicant is under 18) Title First Name Last Name Suffix Parent/Guardian Email Address (if applicant is under 18) Parent/Guardian Phone Number Check if applicant address is the same as parent/guardian above. Same Address Applicant Mailing Address Address Line 1 Address Line 2 City State Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC Zip/Postal Code Applicant Email Address * Applicant Phone Number * High School Currently Attending (select one) * Riverwood International High School North Springs High School Number of Years Attending This School, Including Current Year (Note: students must attend this school for a minimum of two years) * 2 Years 3 Years 3 Years Cumulative, Numeric Grade Point Average On 100-Point Scale (Minimum GPA 79) * I am a US Citizen or have Permanent Resident Alien Status. (Upon request, I will provide the Scholarship Committee with a social security number.) * Yes No I have completed the FASFA form and have an ID. * Yes No I am planning to attend one of the following non-profit, technical, associate or 4-year public college or public university accredited by the University System of Georgia: (list up to 4 schools) * I plan to enroll for the following year: * I plan to enroll for the following semester: * Part II: Written Essay (max 500 words on (i) why you have a need for financial aid, and (ii) why you want to continue your education.) * Part III: Non-Relative Recommendations Applicants must provide two (2) typewritten personal letters of recommendation from non-relatives (max 500 words). Non-relatives include employers, teachers, pastors, etc. Name of Non-Relative Recommendation #1 Title First Name * Last Name * Suffix Address of Non-Relative Recommendation #1 Address Line 1 * Address Line 2 City * State * Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC Zip/Postal Code * Phone of Non-Relative Recommendation #1 * Email Address of Non-Relative Recommendation #1 * Name of Non-Relative Recommendation #2 Title First Name * Last Name * Suffix Address of Non-Relative Recommendation #2 Address Line 1 * Address Line 2 City * State * Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC Zip/Postal Code * Phone of Non-Relative Recommendation #2 * Email of Non-Relative Recommendation #2 * Non-Relative Recommendation Letter #1 (if available) * Non-Relative Recommendation Letter #2 (if available) * Part IV: Consent Form You may fax, mail, or email consent form. See link on Scholarship page. Additional Information The Scholarship Committee may request additional information. Additional information can be sent via email or mailed to: The Donna Adams Mahaffey & Jean DiLuzio Scholarship, c/o Sandy Springs Perimeter Civic Fund, Attention: Adam Forrand, 1000 Abernathy Road, Suite L10, Sandy Springs GA 30328 | Phone: 678.443.2990 | Email: civicfundsspc@gmail.com
