BERNICE HOLLINGER MEMORIAL SCHOLARSHIP APPLICATION

Complete and Return to:

The G. W. Hollinger Sr. Foundation, Inc.
Ms. Clara Hutchings, Scholarship Committee Chair
P.O. Box 1705
Monroeville, Alabama 36460

The school must send copies of the official transcript before this application can be considered.

Part I- Personal Data (Type or print in ink)

Name ________________________________________________________________________________
Last First Middle

Permanent Address ____________________________________________________________________

Street City State Zip

Home Phone Number __________________________ Cell Number______________________________

Birth date ______________________ Single ______ Married _______

Father’s Name ________________________________________________________________________

Address ______________________________________________________________________________
Street City State Zip
Occupation ___________________________________________________________________________

Mother’s Name _______________________________________________________________________

Address ______________________________________________________________________________
Street City State Zip
Occupation ___________________________________________________________________________

Guardian (if applicable) _________________________________________________________________

Address ______________________________________________________________________________
Street City State Zip
Occupation ___________________________________________________________________________

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Part II- Family Income

(Please complete all information)

Yearly Gross family income (before taxes) _________________________________________________

Number of adults in household _____________ Number of children in household_________

Number of children in college Fall 2021 (including yourself) _____________

Do you plan to work during the summer? Yes No

Part III- Educational Background

(Please complete all information)

High School(s) attended

School Name ________________________________________________________________________
Location ____________________________________________________________________________

Dates Attended _____________________ Class Rank ___________of______________

Honors
_____________________________________________________________________________________
_____________________________________________________________________________________

Additional School Name If Applicable ___________________Location ____________________________

Dates Attended _____________________ Class Rank __________of_______________

Honors
_____________________________________________________________________________________

_____________________________________________________________________________________

Technical Training, Certifications

_____________________________________________________________________________________

_____________________________________________________________________________________

Clubs and Organizations (Provide the name of the organization(s) and position(s) held
_____________________________________________________________________________________
_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

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Part IV-Work Experience and Other Activities

Work experience (Provide employer, job title, dates of employment)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Sports, Performing Arts and/or Any School Extracurricular Activities

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Community/Civic Activities

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Special Talents (Ex. Speaking, People Skills, Music/Piano, etc.)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Other Activities

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

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Part V- School Information

Do you plan to enter college or technical school for the Fall Semester? Yes No

Name of school you plan to attend in the fall. ____________________________________________

Part VI- Application Requirements

The application packet must be postmarked on or before April 20, 2021.

Only students who are candidates for graduation this Spring 2021 and who plan to attend a
college/university or technical school will be considered for the scholarship.

Completed requirement application checklist:

________ Application

________ Photograph of Yourself

3 Character Recommendations (Letters must be written on appropriate letterhead and placed in sealed
envelopes and should come from):

________ High School Principal or Counselor

________ High School Teacher

________ Spiritual Leader (Pastor, Rabbi, Sunday School Teacher, Church Youth Leader, etc.)

________ A 250 words double-spaced typed essay, indicating your ambitions and goals for the future.

________Transcript which includes unweighted GPA, & Class Ranking ( ___of____)

Note: Transcripts must be mailed directly from the school.

If selected, the scholarship will be awarded after notification of enrollment into a college or university.
The scholarship recipient must maintain a GPA of 2.5 or higher to retain the scholarship.

I declare that all information provided in this application is accurate. I have requested that my official
High School Transcript be mailed to the G. W. Hollinger, Sr. Foundation, Inc.

I agree to accept the decision of the Scholarship Committee.

_________________________________________ __________________
Signature Date