FORMAL EDUCATION SCHOLARSHIPS $5000 Scholarship Application $2500 Scholarship Application $1500 Scholarship Application $1000 Scholarship Application
All applicants must be high school seniors and have applied to a college or university for admission in the Fall of 2016. All applications must be completed accurately and completely and returned to a Tip Top Tux location prior to March 1, 2016. Acceptance of the scholarship is an acknowledgement that Tip Top Tux may use your name and/or likeness in its advertising and promotional material without additional compensation. Scholarships may not be exchanged for cash and are not transferable. Scholarship funds will be sent directly to the student’s school of choice upon acceptance and admittance. Scholarship winners who are not admitted to college by August 15, 2016 will not be awarded a scholarship. The scholarship recipient is responsible for the lawful reporting and payment of any applicable local, state or federal taxes. The decision of Tip Top Tux is final. Employees and family members of employees of Tip Top Tux are not eligible. All information supplied is confidential and will be used only in conjunction with this scholarship program. Supplying false or misleading information will result in immediate disqualification.
APPLICANT INFORMATION LAST NAME_______________________FIRST NAME________________________M.I.______________ DATE OF BIRTH____________________GENDER________ ADDRESS_____________________________________________________________________________ CITY_________________________________________________STATE________________ZIP________ CELL PHONE (____)_______________EMAIL________________________________________________ PARENT / GUARDIAN NAME_______________________________TELEPHONE (____)________________ HIGH SCHOOL NAME_________________________________GRADUATION DATE___________________ CITY____________________________________STATE___________GRADE POINT AVERAGE_________
LIST IN ORDER OF PREFERENCE THE COLLEGES/UNIVERSITIES YOU HAVE APPLIED TO: 1.__________________________________________
ACCEPTED?
Y
N
2.__________________________________________
ACCEPTED?
Y
N
3.__________________________________________
ACCEPTED?
Y
N
YOUR INTENDED FIELD OF STUDY_________________________________________________________
HIGH SCHOOL ACTIVITIES – List your most important athletic, scholastic or community activities in which you have participated. Include any office or titles held and any significant achievements. 1.____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 2.____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 3.____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
EMPLOYMENT INFORMATION – List any jobs you’ve held while in high school and any significant contributions you made to your place of employment. 1.____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 2.____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 3.____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
OTHER NOTEWORTHY ACHIEVEMENTS – Please list any additional information accomplishments, awards or recognitions received during your high school years. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
FAMILY/FINANCIAL INFORMATION 1. Have you applied for Financial Aid? Yes________No_________ 2. Annual income for: Parents____________________________Student__________________________ 3. Siblings-Please list any siblings living at home or school Name Age Name of College or University ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ________________________________________________________________ 4. Awards-Please list below any Financial Awards you have received from the colleges to which you have applied. Include name of school, scholarship and amount. ____________________________________________________________________ ____________________________________________________________________ _________________________________________________________________ LETTERS OF RECOMMENDATION – Please attach two (2) letters of recommendation from an adult who knows you well, but is not related to you. At least one letter must be from a teacher, principal, coach or counselor at your high school. Your other letter may be from an employer, friend, clergyperson or any other person able to present your personal qualities and accomplishments. HIGH SCHOOL TRANSCRIPT – You must attach a copy of your most recent high school grade transcript. PERSONAL ESSAY – Please attach a typewritten essay, not to exceed 500 words, describing your educational, career and life goals, and explaining why you feel the FORMAL EDUCATION Scholarship Program of Tip Top Tux should help you achieve them by investing in your education. I HAVE READ AND ACCEPT THE TERMS OF THIS APPLICATION. THE INFORMATION ON THE ABOVE APPLICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE. ALL INFORMATION SUPPLIED IS CONFIDENTIAL.
APPLICANT’S SIGNATURE
DATE
PARENT/GUARDIAN SIGNATURE *Necessary if Recipient is under 18 years of age at time of signing.
DATE
Scholarship Recipient Agreement In consideration of the scholarship provided by Tip Top Tux the undersigned Recipient hereby acknowledges and agrees to the following conditions: 1.
The scholarship offered may not be exchanged for cash or its equivalent.
2.
The scholarship offered is not transferable to another person.
3.
The scholarship will be paid directly, via check, to the accredited college or university to which the recipient has been accepted and been admitted. Verification of acceptance and admittance is required prior to the scholarship payment being applied.
4.
In the event the Recipient does not attend an accredited college or university within 12 months of being awarded this scholarship, for any reason whatsoever, the awarded scholarship shall lapse and no scholarship will be awarded.
5.
The Recipient is responsible for the lawful reporting and payment of any applicable taxes, whether local, state or federal, that may be applicable to the award of the scholarship.
6.
The Recipient agrees to attend a ceremony hosted by Tip Top Tux to recognize all Recipients and take photographs.
7.
The Recipient agrees to the use of his/her name and or likeness in any advertising or promotional materials by Tip Top Tux without additional approval or additional compensation.
Date Signed ____________ Recipient____________________________________________________ Parent/Guardian______________________________________________ *Necessary if Recipient is under 18 years of age at time of signing. Submit Application to any Tip Top Tux Retail store or mail to: Tip Top Tux Attn: Nancy Haboush, VP of Sales 500 Floyd Blvd. Sioux City, IA 51101
