Indian Cultural Center

Scholarship Application

Please Provide All Requested Information; incomplete applications will be rejected.
Additional information including Social security numbers and Income Verification may be required if you are selected as a Scholarship Recipient.
Deadline for submission is June 12, 2024

First Name ^*

Middle Name ^*

Last Name ^*

Date Of Birth ^*

Email^*

Home Phone [Only numbers allowed.]^*

Mobile Phone [Only numbers allowed.]^*

Permanent Address ^*^*

City

State/Province

Zip/Postal

Name of College you are/will be attending

Contact at School

Contact Phone Number [Only numbers allowed.]

Anticipated Year of Graduation College

Current GPA College/High School

Your Education costs:

Tuition $

Room, Board and Other costs

HighSchool Information

Graduation year

SAT Score

GPA (Senior Year High School)

Parent’s information

Father's Name ^*

Mother's Name^*

Father's Employer ^*

Mother's Employer ^*

Father's Employer's Phone Number ^*

Mother's Employer's Phone Number ^*

Father's Occupation ^*

Mother's Occupation ^*

Parents Address (Only if different from your Primary Address) ^*

City ^*

State/Province ^*

Zip/Postal ^*

Household gross income for the previous year: Please be accurate a copy of last year family’s tax return, both returns if filing separately will be required for verification if applicant is chosen

List all those Excluding yourself, who will be dependent upon and supported by your parental income:

Click ADD to include additional dependants

Dependants Name

Age

Relationship to Parent

Name of College

Estimated education costs

Total Scholarships

Total Loans (Non-family)

Total Parental support

ADD

Sources of Financial assistance and scholarships:

Family - $

Federal aid - $

State aid - $

School - $

Prior year ICC support - $

Other - $

Other income:

Stipends - $

Other - $

Number of siblings attending:

Public School

Private School

State College

Private College

College debt

Outstanding student loans - $

Have you received any AIP/ICC support in the past?

Received Support? Yes
No

When/How Much

List all awards, honors, scholarships and extracurricular activities you have engaged in:

Write a Summary statement in support of your application including any special circumstances that should be considered:

List all current community service, especially involvement in the South Jersey Indian Community

Personal Statement: Five sentences or less as to why we should consider candidacy

Upload Transcripts

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Certificate
“I do hereby certify that the information provided is true and accurate to the best of my knowledge.”

Application Date

Signature of Applicant

If minor, Name and Signature of Parent

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