EXPERIMENTAL AIRCRAFT ASSOCIATION SCHOLARSHIP APPLICATION FORM

I wish to apply for the selected scholarship(s). You may make multiple selections (To select multiple entries, use Control + Click for PC or Command + Click for Mac). A free EAA Student Membership or recommendation from an EAA member is required for application. This membership must be current from date of application and membership number must be that of the applicant or the person recommending them. All fields are required.

I. PERSONAL DATA
First Name:
Middle Name:
Last Name:
EAA Member Number:
or recommended by EAA Member (Name):
EAA number of person recommending you:
Address 1:
Address 2:
Address 3:
City:
State/Province:
Postal/Zip Code: -
Country:
Phone Number:
E-Mail Address:
Age:
    
II. FINANCIAL INFORMATION
(Financial information is not required when applying for Karen Johnson Solo Scholarship.)
 
List other dependents in family and their ages:
Name Age
Adjusted Gross Income of Parents:
From IRS 1040
Applicant's Gross Income:
From IRS 1040
Applicant's Spouse's Gross Income:
From IRS 1040
Other source of income:
  
III. EDUCATIONAL DATA
A. What post-secondary institution do you plan to attend? (Please include address) (first choice)
(second choice)
Have you been accepted? First choice  Second choice
Do you plan to attend full time? Yes  No
B. Projected expenses for year in which assistance is requested: Tuition
Fees
Books and Supplies
Other Expenses - Explain below
  
  Total
C. Record of High School Education
Applicants must forward original certified high school transcript showing rank in graduation class if requested.
 
Name and address of high school  
1.
From
Month/Year
To
Month/Year
Diploma
Month/Year
2.
From
Month/Year
To
Month/Year
Diploma
Month/Year
3.
From
Month/Year
To
Month/Year
Diploma
Month/Year
D. High School Scholastic Honors and/or Awards
E. Record of College Education
Applicants must forward original certified college transcript showing rank in graduation class if requested.
 
Name and address of college  
1.
From
Month/Year
To
Month/Year
Diploma
Month/Year
2.
From
Month/Year
To
Month/Year
Diploma
Month/Year
3.
From
Month/Year
To
Month/Year
Diploma
Month/Year
F. College Scholastic Honors and/or Awards
G. Will you receive other scholarships/grants? Please identify
H. (If available) A.C.T. Score
  S.A.T. Score
  
IV. ACTIVITIES (High School or College)  
A. School Activities
(Years of membership, offices held, student government, athletics, clubs, social, etc.)
  
V. WORK EXPERIENCE
List present and past employment and volunteer work experience beginning with your most recent job.
 
Name and address of employer:  
1. Employer Name
Employer Address
Type of Business
From: Month/Year To: Month/Year

Job title/duties

    
2. Employer Name
Employer Address
Type of Business
From: Month/Year To: Month/Year

Job title/duties

    
3. Employer Name
Employer Address
Type of Business
From: Month/Year To: Month/Year

Job title/duties

   
4. Employer Name
Employer Address
Type of Business
From: Month/Year To: Month/Year

Job title/duties

   
Do you plan to do outside work while attending school? Yes  No
Please explain
 
VI. PERSONAL STATEMENT  

Statement should be 500 words or less. The following items should be addressed:

  1. Career aspirations

  2. Educational plan

  3. Why you want to receive this scholarship

  4. What you learned from work/volunteer experiences

  5. Explain how your education wil be financed, including loans, family assistance, your own savings, scholarships, etc.

  6. Explain any unusual financial circumstances. Is there a family situation that affects your college financial plan?

 
 VII. REFERENCES  
List two references (not family members) familiar with your scholastic performance and/or work and volunteer activities. Contact references to obtain their permission for use of their names, occupation, address and phone numbers.

Name
 

Occupation

Address


Phone Number

Email address
   

Name
 

Occupation

Address


Phone Number

Email address
 
Only scholarship recipients will be notified. Upon selection and written proof of enrollment, a check will be sent to the recipient, payable to the recipient and the college of choice. The application must be received no later than February 28, 2014, unless otherwise stated.
 
By this submission I hereby certify that the information I have submitted is true and correct to the best of my knowledge. Additional information or verification may be requested. Sponsors of EAA may without notification withdraw any scholarship that has not been awarded.

       

For questions or problems with this form contact the
 EAA Education Department at 920-426-6823
or
scholarships@eaa.org