Scholarship Form

Contact Information

Name *

Address *

Zip *

City *

State *

Home Phone *

Cell Phone *

Email *

Date of Birth *

Age *

Last 4 Digits of SS# *

Are you currently an American Citizen? Resident Alien status does NOT qualify. Applicant MUST be a citizen on the date the application is submitted. *

Do you or your family have an existing customer relationship with the bank? *

What high school are you graduating from? *

ACT/SAT Score *

State your plans for enrollment in an accredited American college, university or tech school. Include your planned major. *

Have you been granted scholarship aid? *

Do you intend to apply for financial aid at the college you plan to attend? *

Employment

List all the jobs you've held. Please include baby-sitting and work on a family farm or family business, even if not paid.

Employer/Organization *

Position/Type of work *

Start Date *

End Date *

Community Service

List any volunteer work or community service you have performed.

Organization *

Type of work *

Start Date *

End Date *

Honors and Awards

Please list all scholastic, extracurricular and civic honors and awards received during grades 9 through 12. (ex. Science Award 10, 11, 12)

Name of Award *

Grade *

Positions of Leadership

State the name of the organization, position and grade(s) position was held between grades 9 through 12, starting with the most recent.

Name of Organization *

Position *

Grade *

Activities and Organizations

Include all scholastic, extracurricular and civic organizations that you participated in between grades 9 through 12, even those listed in the Positions of Leadership section.(ex. Boy Scouts: 9, 10, 11)

Name of Organization *

Position *

Additional Information

Transcripts * Please upload your high school transcripts.

Letters of Recommendation * Please upload two letters of recommendation completed by a high school teacher, counselor or work supervisor who knows you well.

Essay * In 500 words or less, please explain your college choice, career aspirations and why you feel you are deserving to be a recipient of a Peoples Bank & Trust Co. Scholarship. Please upload this file here.

Financial Aid (SAR) If you have a complete copy of your Student Aid report (SAR), please upload it here. The SAR is the official record that your Free Application for Federal Student Aid (FAFSA) was processed

Financial Situation * Please tell us your current financial situation as it relates to your post-high school education. Are you receiving any additional scholarships, grants, or have access to funding through your family? Please upload this file here.

Permission for Use of Photo and Waiver of Claims

I, in connection with the receipt of an academic scholarship sponsored by Peoples Bank & Trust Co., posed for photographs. At the time such photographs were taken, it was explained to me that such photographs would be the sole property of Peoples Bank & Trust Co. and would be used for promotional purposes by Peoples Bank & Trust Co., and possibly by others that it might transfer the photographs too. It was explained to me that such photographs could be used for advertising purposes on billboards, internet, e-mail, magazines, pamphlets, fliers and other types of media and for such other purposes as Peoples Bank & Trust Co., or its assigns, might deem appropriate, in its sole discretion. I grant Peoples Bank & Trust Co., and its agents, employees and assigns, permission to use such photographs in such manner and for such purposes as they, in their sole discretion, may deem appropriate or advisable. I hereby waive and release any claim of ownership to such photographs and further waive and release any claim or action against Peoples Bank & Trust Co., its agents, employees and assigns and agree to hold each of them harmless for any injury or harm resulting or arising from any use by them of the photographs.

Agree *