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Applicant's Name:  
Address & Telephone:  

SCHOLASTIC, EXTRACURRICULAR & CIVIC ACTIVITIES:

Month & Year of Graduation:          Class Rank:  
Honors and Awards:
 
 
 
 
 
Offices & Positions of Leadership Held:
 
 
 
 
 
Memberships in Organizations: 
 
 
 
 
 
 

PLANS FOR COLLEGE:

Which accredited American college or university do you plan to attend?
 
 
Have you been granted scholarship aid?      If so, please provide details below:
 
 
 
 
Do you intend to apply for financial aid at the college you will attend?       If so, please give details:
 
 
 
 
Have you reason to expect scholarship aid from other sources?       If so, please give details:
 
 
 
 
Do you plan to seek employment to aid in defraying expenses incurred by furthering your education?
 
 
 
 

FINANCIAL ASSESSMENT:

How many dependent brothers and sisters are living at home? 
 
How many dependent brothers and sisters are attending college?  
 
Do you have other sources of income (specify monthly or annual)? 
 
What is your father's occupation? 
 
What is your mother's occupation? 
 

 

What is your gross family income range?*      Up to $15,000
      $15,000 to $25,000
      $25,001 to $35,000
      $35,001 to $45,000
      Over $45,000

 

       
Applicant's Signature    Date 

 

If you have questions about this application, please feel free to contact The Citizens Bank of Weston, Inc. at area code 304/269-2862 and ask for Tracey Hager, Vice President.

    PLEASE RETURN YOUR APPLICATION FORM AND PERSONAL STATEMENT TO:

Chief Executive Officer
The Citizens Bank of Weston
P. O. Box 310
Weston, WV  26452

*By bank policy, all information received will be handled with confidentiality.  Only bank management or members of the bank's board of directors involved in the scholarship selection process will have access to applications and information contained therein.