RJS Scholarship Application - Peoples Services

"*" indicates required fields

Step 1 of 10

10%

Full Name of Applicant

Prefix First Last Suffix

Phone*

Email*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Citizenship*

Date of Birth*

Social Security Number*

Mother's Name

First Last

Occupation

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Father's Name

First Last

Occupation

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Siblings/Other Dependents
Please list names and ages of siblings/other dependents and indicate what school(s) they attend.

Name

Relationship

Age

School/Years Attended

Name

Relationship

Age

School/Years Attended

Name

Relationship

Age

School/Years Attended

Name

Relationship

Age

School/Years Attended

List all secondary and/or technical schools you have attended in the last (5) years, beginning with the school you presently attend.*

How many years do you plan to attend college, university or vocational school and what course of study would you like to pursue?

Course of Study*

Years*

What future business, technical, professional or educational career will you likely pursue after finishing college?*

What college, university or vocational school would you most like to attend? Please explain your reason.*

What colleges, universities or vocational schools or programs have you applied to? Please indicate acceptance status.*

List scholarships, grants or loans for which you have applied and check ones you plan to use. If applicable, indicate funding amount you will receive.

Scholarship, Grant, or Loan Name

Amount

Plan to Use

Yes

Scholarship, Grant, or Loan Name

Amount

Plan to Use

Yes

Scholarship, Grant, or Loan Name

Amount

Plan to Use

Yes

Scholarship, Grant, or Loan Name

Amount

Plan to Use

Yes

Use additional pages or attach resume for section, if necessary.

List academic awards, achievements and dates.

List participation in athletic activities

List participation in comunity service and extra-curricular activities.

Additional Activity Information Upload

Max. file size: 128 MB.

List jobs you have held in the last three years.

Employer

Dates

Position

Salary

Employer

Dates

Position

Salary

Employer

Dates

Position

Salary

College/School

Tuition

Room/Board

Clothing/Personal

Entertainment

Transportation

Scholarships Available

Total Annual Cost

College/School

Tuition

Room/Board

Clothing/Personal

Entertainment

Transportation

Scholarships Available

Total Annual Cost

College/School

Tuition

Room/Board

Clothing/Personal

Entertainment

Transportation

Scholarships Available

Total Annual Cost

Complete this section regarding estimated combined net income of you, your parent(s), or guardian(s) for the current year.
Please submit copies of any documentation necessary to prove your “dependent” relationship to an employee of Peoples Services, Inc. or its subsidiaries.

Name of Person

Income and Year

Total Annual Income

Name of Person

Total Annual Income

Income and Year

Name of Person

Income and Year

Total Annual Income

Have you filed a FAFSA (Free Application for Federal Student Aid)? If so, please submit a returned copy showing your EFC (expected family contribution).

Yes

EFC Upload

Max. file size: 128 MB.

Describe any special circumstances such as medical conditions, disabilities, etc. that may affect your ability to pay for your college tuition.

Submit a certified transcript of your high school record and ACT/SAT score(s). If you are already enrolled in post-secondary school, submit your current transcript record as well.

Max. file size: 128 MB.

In 500 words or less, tell us about your educational and career goals, aspirations and objectives, including what motivated you to pursue your chosen field of study. **

I do state the above information is accurate to the best of my knowledge.
I understand that my online application contains confidential personal data. I hereby authorize RJS Family Foundation to review the information in my application for the purpose of determining my eligibility for the RJS Family Foundation Scholarship. I also understand and agree that RJS Family Foundation may transfer, store and process my application data in any of its offices only in conjunction with the selection process for the RJS Family Foundation/Peoples Services, Inc. General Scholarship Fund Program. I verify that I have read, understand and agree to the guidelines for this program. By registering for an application account, I consent to the preceding statement and to the guidelines for the RJS Family Foundation Scholarship Fund Program.

Signature*

Please type your full legal name

Date

MM slash DD slash YYYY

Electronic Signature and Consent

By checking this box and signing my name above, I am electronically signing my application.

I have read and agree to the preceding Consent Statement. I also understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.