SCHOLARSHIP APPLICATION

The application period for 2005 has ended!

Applications for 2005 must be submitted between January 1 and April 30, 2005.

(For best results we recommend that you print this form directly from the website, however it may be copied and pasted in Adobe Acrobat, Microsoft Word or other word processing programs.)

Dear Student:

Thank you for your interest in the U. S. Marine Corps Food Service Association Scholarship Program.

This application for 2005 must be printed and completed offline and mailed to the address provided below. Applications must be postmarked after midnight January 1, and before midnight April 30, 2005 in order to be considered.

Please note that the following additional requirements must be met in order for your application to be considered by the Scholarship Committee.

Complete this application carefully and completely. Illegible or incomplete applications will be returned.
All applicants must have dependent status as defined by the Internal Revenue Service.
All applicants must have a parent or grandparent who is a member in good standing of the U S Marine Corps Food Service Association, Inc.
The Enrollment Verification Form, page 6 of this Scholarship Application, must be completed and signed by the school you will be attending and must be returned to this office immediately following your registration for the Fall Semester . This form may be mailed or faxed by you or your schools Financial Aid Office. No scholarship awards will be sent until this form has been received
Applications must be postmarked no later than midnight April 30, 2005.

Please do not hesitate to contact our headquarters if you have questions regarding this application.

PERSONAL INFORMATION

Complete this form in its entirety. Attach all required documentation and mail to Scholarship Committee, USMCFSA, 1001 McArthur Drive, Jacksonville, AR 72076. Incomplete or illegible applications will be returned. When your school’s policy dictates, TRANSCRIPTS ONLY may be mailed under separate cover. Completed applications must be postmarked before midnight April 30, 2005.

DATE:

NAME:

SOCIAL SECURITY NUMBER:

DATE OF BIRTH:

ADDRESS:

CITY:

STATE:

ZIP:

TELEPHONE: ( )

EMAIL:

Applicants must have:

a. Dependent status. IF MORE THAN HALF OF YOUR SUPPORT FOR THE YEAR IS PROVIDED BY ANOTHER PERSON, YOU CAN GENERALLY BE CLAIMED AS A DEPENDENT. THAT PERSON WILL USUALLY BE YOUR PARENT OR SOMEONE ELSE RELATED TO YOU AND WHOSE HOUSEHOLD YOU ARE A MEMBER OF. ( Visit www.irs.ustreas.gov review Publication 4, Students Guide to Federal Income Tax)

b. A Parent or Grandparent who is a member of U. S. Marine Corps Food Service Association in good standing. (USMCFSA)

USMCFSA Member Name:

USMCFSA Member Number:

ADJUSTED GROSS income from IRS FORM 1040, 1040A, or 1040EZ AND Copies of tax returns for 2004, showing adjusted gross income, dependent status for applicant and signature of each taxpayer MUST accompany your application or application will be returned).

SUPPORTING DOCUMENTS

The following documentation must accompany this application. Failure to provide ALL of the following materials will result in disqualification and applicant will NOT be considered.

1. Three hundred (300) word essay on “What America Means To Me.”

2. Two (2) letters of recommendation from instructors from your current school. These recommendations must accompany this application.

3. A copy of your most current high school or college transcript. If the school will be sending this transcript under separate cover, attach a brief note to that effect.

4. A copy of the letter of acceptance from the institution you plan to attend.

5. A recent 2”x3” photograph of yourself. ( Used for publicity only).

6. A completed, notarized Applicant Liability Release Form (form on page 5).

7. Copies of IRS FORMS, required on Page 2.

Applications that do not contain ALL support documentation will be returned!

In return for consideration for a scholarship award by the U S Marine Corps Food Service Association, I hereby agree to protect and hold harmless the U. S. Marine Corps Food Service Association, the U. S. Marine Corps Food Service Association Scholarship Committee and/or their legal representatives in the use of personal information, photographs, and other materials provided in the application, and/or as an attachment to the application, and/or as supplemental information provided by others at my request in support of the application. I further hereby agree to permit the U. S. Marine Corps Food Service Association Scholarship Committee to reproduce said materials, including photographs as may be required, and to allow the U. S. Marine Corps Food Service Association and/or the U. S. Marine Corps Food Service Association Scholarship Committee to contact me at a future time regarding my child’s Scholastic Accomplishments following receipt of scholarship funds which may be awarded by reason of this application. Additionally, I certify that my child has dependent status as defined on page 2 of this application and that he or she is a (□ child) (□ grandchild) of U. S. Marine Corps Food Service Association Member in good standing □ MR. □ MRS. □ MS. , who holds

Member Number _______________.

Applicant Name: (printed)

Social Security Number:

Address:

City, State, Zip:

Personally appeared before me and acknowledged to me that he/she/they executed this instrument of his/her/their free will and deed.