THE RUBY HOLLAND FOUNDATION, LLC

POST OFFICE BOX 847

APOPKA, FL 32704-0847

APPLICATION SCHOLARSHIP GRANT FOR COLLEGE

DEADLINE: MARCH 4TH, 2021

Candidates must complete ALL sections. If not applicable, please note by writing N/A

    Name

    Home Address

    Mailing Address

    Home Phone Number

    Cell Phone Number

    Email Address

    Date of Birth

    Parents or Guardian

    ARE YOU A UNITED STATES CITIZEN OR LEGAL RESIDENT?

    YesNo

    Section A

    By applying for this scholarship, I give The Ruby Holland Foundation, LLC. permission to publish my name and/or utilize my photograph.

    High school name and address District GPA Florida GPA Score on SAT, if taken Score on ACT, if taken Classes taken for High School Credit: Number of AP Classes Number of IB Classes Number of Dual Enrollment Classes Number of Honor Classes List any Scholastic or Academic Awards (9-12)

    Section B

    Are you a dependent (claimed on parents’ income tax) or independent?

    Select your gross family income or your own income if you are independent. *Attach W-2 and/or FAFSA

    Under $25,000$25,000 to $40,000$41,000 to $65,000over $65,000

    Who contributes money for your education? (parents, self, other) Please list:

    List any scholarships, grants, and loans you are receiving or for which you have applied.

    Are you employed? If yes, where? How many hours do you work weekly?

    Section C

    You must complete Section C using this form only.

    List total hours of Community Service

    List Community and/or School-Related Extra-Curricular Activities such as Clubs/Organizations (Grades 9-12)

    Activity Number of Years Participated Awards, Honors or Leadership Roles (No. Years)

    List Community and/or School-Related Sports Participation (Grades 9-12)

    Sport Number of Years Participated Awards, Honors or Leadership Roles (No. Years)

    List Community and/or School-Related Music/Theatre/Drama/Dance Participation (Grades 9-12)

    Activity Number of Years Participated Awards, Honors or Leadership Roles (No. Years)

    Applicant Signature

    I affirm that all the statements on this application are true.

    Use mouse to complete signature

    Date

    Email the below listed documents to info@rubyhollandfoundation.org All documents must be received before midnight of the deadline date of 11/20/20

    • Copy of parent(s) W-2 Form(s) and/or FAFSA with income clearly indicated
    • Two letters of recommendation
    • Personal letter outlining your school experiences and goals
    • Information of any special circumstances you feel are relevant
    • A recent photograph of yourself
    • Official Transcript