Scholarship Application  Continuation - page 2 of 2

Mother: Name _________________________________________________________________________ Address _______________________________________________________________________ Occupation ___________________ Employer______________________ Annual Salary ________ (If parents are not living, give name and address of guardian or nearest living relative) Total income of your parents _______________________________________________________ Total number of dependents your parents support _______________________________________ (Give their ages and relationship _____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ College expenses for other dependents: Are you dependent upon your parents for your support? __________________________________ What is the approximate amount they will be able to contribute annually toward you college expenses? _____________________________________________________________________________ IMPORTANT:  Include with this application a LETTER IN YOUR OWN HANDWRITING stating why you need a scholarship and what you are considering as life work (vocation).  Enclose a recent passport size PHOTO of yourself with name, address and birthday on the back. REFERENCES:  One of each type        1. Scholastic               2. Character              3. Financial Responsibility               4. Any other

1.  Name ____________________________ Position _________________________      Address __________________________________________________________ 2.  Name ____________________________ Position _________________________      Address __________________________________________________________ 3.  Name ____________________________ Position _________________________      Address __________________________________________________________ 4.  Name ____________________________ Position _________________________      Address __________________________________________________________

If applicable, recommended by the Garden Club of North Carolina member: Name _________________________ Address _________________________________________ I certify that I have truthfully and accurately answered the foregoing questions to the best of my knowledge and belief, and I understand that any false or concealed information will be grounds for rejection of my application or subsequent termination of my scholarship.

_____________________________________                         Signature

ALL APPLICATION MATERIALS AND REFERENCE LETTERS MUST BE COMPLETE AND SENT IN BY MARCH 1 TO STATE HEADQUARTERS:  The Garden Club of North Carolina, Inc., PO Box 33520, Raleigh, NC 27636-3520

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