MENLO-ATHERTON HIGH SCHOOL SCHOLARSHIP FORM All information on this form will remain absolutely confidential within the Menlo-Atherton Scholarship Committee. Name Student Number Address Home/Apartment Number Street City, State Zip Code GPA SAT CR SAT M SAT WR Parent Name Occupation Employer Father: Mother: Are you a U.S. citizen? Yes         No If no, what is your citizenship status? Racial/ethnic heritage: To what colleges/schools will you apply? What are your occupational goals? Please list your school activities (sports, clubs, etc.). Indicate any offices held. Please list your community activities (church, scouts, service, etc.). Please list your work experience: Please list any honors/awards (academic or extracurricular) you have won. Date: Signature: PLEASE COMPLETE THE FOLLOWING SECTION IF FINANCIAL NEED IS A CONSIDERATION Please attach recent photo here: If you are interested in applying for those scholarships where financial need is a consideration, the following questions must be completed by a parent/guardian. The information submitted will be considered confidential and is sought only to assist the Scholarship Committee in making awards and recommendations according to the financial need of the applicants. Check one: Father Stepfather Legal Guardian Other: Name: Married Divorced Separated Remarried Deceased Widower Gross income last year: $ Check one: Mother Stepmother Legal Guardian Other: Name: Married Divorced Separated Remarried Deceased Widow Gross income last year: $ Student lives with: Both parents Father Mother Legal Guardian Other: Combined gross income if student lives with both parents: $ Who is financially responsible for this student? If applicable, what is the amount of child support payments, Social Security, or other benefits for the applicant per year? Asset information (for person(s) financially responsible for this student): Cash, savings, and checking accounts: $ Home market value: $ Other real estate and investments: $ Automobiles: $       Make, model, and year: What is owed on home mortgage? $ Monthly mortgage payments: $ Monthly rent? $ Number of children supported by financially responsible person(s) listed above who are:     Living at home:         In college: Are there any other funds (i.e., trust funds, grandparents, etc.) available to help fund this student's continuing education? Please explain any unusual financial circumstances that you think should be considered (use a separate sheet if necessary). I declare that, to the best of my knowledge and belief, the above financial information is true, correct, and complete. I agree to notify the Scholarship Committee of any changes in my/our financial situation. I also agree to submit, if needed, a copy of my most recent IRS tax return upon request. I further agree to advise the Scholarship Committee of any notification of scholarships, awards, or grants received by my son/daughter. _____________________________________________ parent signature / date Feel free to attach extra sheets if necessary.