Eastridge Community Church

Application for Scholarship

T.J. Hailey Annual Scholarship

Mail application to:

Eastridge Community Church
T.J. Hailey Scholarship Committee
863 Hwy. 142 East
Covington, Ga. 30014

As we have opportunity, let us do good unto all men, especially unto them who
are of the household of faith.
Galatians 6:10
In 2003, Eastridge Community Church and the family and friends of T.J. Hailey established a
scholarship fund in his honor. T.J.s life was cut short by a tragic car accident on March 26,
2003. With this scholarship fund being created, T.J.s life and memory will live on by helping
others which T.J. spent his entire life doing. Applicants must be a member of
Eastridge Community Church and meet the attached criteria.

THE DEADLINE TO APPLY IS SUNDAY MAY 26, 2013 (Application can be mailed in prior to
this day or dropped off at the Information Center this day no later than noon.)

What will the scholarship cover?

The T.J. Hailey Scholarship will offer two (2) $1,000.00 dollar scholarships each year. The
recipients will be recognized during the Sunday morning second service at Covington
Campus on June 9, 2013. Checks will be mailed to the school upon verification of enrollment.

Who should apply?

Outstanding High School Seniors and students already enrolled in college may apply. We will
award one (1) $1,000.00 scholarship to a high school senior and one (1) $1,000.00
scholarship to an existing college student. Preference will be given to first time applicants, but
returning applicants (not recipients) are welcome to apply. Applicant must be a member of
Eastridge Community Church.

Application Process:
1. Fill out the application form, sign, and mail to the address on the front cover.
2. Have your parents or guardian fill out and sign the Financial Statement section of the
application form.
3. Include two letters of current recommendation. The two letters should come from
individuals who have a good knowledge of your moral character, achievements and
potential. One recommendation should be from a church official and one from a person other
than a relative.
4. Include a copy of your latest high school transcripts if a graduating senior, a copy of grades
if you are already enrolled in college, and your ACT or SAT results.
5. Include a personal essay. It may be 150 words or less, handwritten. Your career
objectives, how college ties into that, how Eastridge has impacted your life, and how you
expect to contribute to society can form the basis of your essay. The essay provides a way in
which to become better acquainted with you, by means other than your achievements, by
enabling you to demonstrate your ability to organize your thoughts and express yourself
clearly.

Checklist-Include all items listed below:

_____Complete application
_____Financial Statement, may include IRS form
_____Letter of Recommendation from Church Official
_____Letter of Recommendation from person other than a relative
_____High School Photo or Other Photo
_____High School Transcript or College Grades and ACT and/or SAT results
_____Handwritten and signed personal essay

Please Type or Print all responses in ink.

Full name of applicant:___________________________Social Security #_________________
Name by which applicant prefers to be addressed:___________________________________
Home address:________________________________________________________________
Home telephone number:________________________Date of Birth:____________________
Parent or Guardian:____________________________________________________________
Address (if different from above):_________________________________________________
Name of High School:___________________________________________________________
Address:_____________________________________________________________________
Overall Grade Point Average:_______________
Performance on National Tests-One Required:
American College Test (ACT) Composite Score____________ Last Date Taken:______________
Scholastic Aptitude Test (SAT) Math and Verbal Score____________ Last Date Taken:________
College or University You Plan To Attend: (Limit Two)
__________________________________
Date Applied:_____________________ Date Accepted:_______________
__________________________________
Date Applied:_____________________ Date Accepted:_______________
Academic Honors, Awards and Leadership Positions categorized as follows:
(use additional pages if needed)
Elected Positions:______________________________________________________________
Volunteer Positions:____________________________________________________________
Club Membership:_____________________________________________________________
Academic Honors:_____________________________________________________________
Work Experience:______________________________________________________________
Other Awards and Honors:_______________________________________________________
____________________________________________________________________________
Signature of Applicant:__________________________________Date:___________________

General Information
Name of Father:______________________________________ Age:____________
Employer:_________________________________ Employers Phone:___________________
Employers Address:____________________________________________________________
Name of Mother:_____________________________________ Age:____________
Employer:_________________________________ Employers Phone:___________________
Employers Address:____________________________________________________________
Name and Ages of Other Dependent Children:
_______________________________________ ___________________________________
_______________________________________ ___________________________________
Other Children in College:_________
Amount of Other Scholarships Committed to Applicant: $_______________
Source of Income
Father

Mother

Salary
Bonuses & Commissions
Dividends & Interest
Real Estate Income
Other Income-Itemize
TOTAL INCOME

LIABILITIES

ASSETS
Notes Payable

TOTAL LIABILITIES
Net Worth (Total Assets-Total Liabilities)
TOTAL ASSETS

Total Liabilities and Net Worth

I hereby certify that the above information is complete and accurate.

_____________________________________________________________
Signature of Parent or Guardian