Name
*
First Name
Last Name
Preferred Name/Nickname
Birthday
*
MM
DD
YYYY
Email
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone or Cell Phone
*
(###)
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Parent or Guardian 1
*
First Name
Last Name
Parent or Guardian 1 Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent or Guardian 2
First Name
Last Name
Parent or Guardian 2 Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent or Guardian 2 Home or Cell Phone
(###)
###
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List names and ages of all siblings living at home or in college.
For those in school or college, provide the name of the school they attend.
Grade Point Average (on a 4.0 scale)
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SAT or ACT Score - Math
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SAT or ACT Score - Verbal
*
Academic Awards / Honors
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Extracurricular Activities and Clubs
*
High School Name
*
High School Phone Number
*
(###)
###
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Guidance Counselor's Name
*
Guidance Counselor's Phone Extension
If you have already been accepted to any colleges, please list them.
Which college/school is your first choice?
Houshold Adjusted Gross Income as reported on previous year's tax return
*
Please select one.
Personal Savings:
*
Parent/Guardian contribution
*
Other individuals' contributions
*
Work-study program or other employment
*
Other scholarships (list all)
*
Student Loans
*
List any volunteer activities you engage in outside of school.
*
List hobbies, interests, and other activities you engage in outside of school.
*
Are you employed during the school year or during the summer? If yes, please indicate your job/duties and number of hours worked per week or month.
*
Are there extenuating circumstances that the CIAO Scholarship Committee should be aware of? If yes, please explain.
*
What are your career plans after college?
*
Biographical Statement: In approximately 500 words, please offer information about yourself that you think the CIAO Scholarship Committee should consider in reviewing your application. For example, you may highlight information such as your passions, hobbies, volunteer activities, employment, family activities, service to your church or community. Let us get to know you!
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Reference 1 Name
*
First Name
Last Name
Reference 1 Email
*
Reference 1 Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Reference 1 Home or Cell Phone
*
(###)
###
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Reference 2 Name
*
First Name
Last Name
Reference 2 Email
*
Reference 2 Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Reference 2 Home or Cell Phone
*
(###)
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Note to Applicant: Before signing and submitting this application, be sure that you have completed all sections, uploaded your transcripts, and uploaded two references.
*
I understand the eligibility requirements. I verify that I personally completed all parts of this application and that all of the information is accurate.
I consent that if chosen as a Scholarship winner, my picture may be taken and used to promote the CIAO Foundation’s Scholarship Program.
I understand that if chosen as a scholarship winner, it is my responsibility to submit to the CIAO Foundation the appropriate information to confirm admission to my educational institution of choice.
I understand that award checks will be sent directly from CIAO to my chosen institution in two equal payments. One payment will be made prior to the Fall Semester and one payment will be made prior to the Spring Semester.
I understand that if for any reason, I do not register as a full-time student for either Semester, I must immediately advise the CIAO Foundation of this fact.
I understand that if my Fall GPA is below 2.0 the award for the Spring Semester may be withheld, pending a review by the CIAO Foundation Scholarship Committee.
Applicant Signature
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Signature Date
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MM
DD
YYYY
PARENT or GUARDIAN: I have reviewed this application and attest to its truthfulness.
*
Parent/Guardian Signature
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Parent/Guardian Signature Date
*
MM
DD
YYYY
