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Eastern States Building Officials Federation
ESBOF Past Presidents Scholarship Awards
Purpose
In accordance with the ESBOF By-Laws Article 10, Section 1, the ESBOF has
established the ESBOF Past Presidents Scholarship Awards. The purpose of the
scholarship is to provide tuition assistance to a child or grandchild of an ESBOF member
for 2015.
Award Benefits
Recipient (s) will be awarded (2) $1,000 Scholarships in April 2015.
Recipient (s) will be presented the Scholarship Award(s) at the Annual ESBOF
Conference Meeting/Luncheon
Eligibility Requirements
Applicant must:
A. The Sponsor of the applicant must be registered for the 2015 ESBOF Conference
by March 15, 2015 (including payment in full).
B. Be scholastically responsible as evidenced by attaining a cumulative grade point
average of a B- (80% or 2.76/4.0) or equivalent at the time of application. If the
application is for 1st year of college, this requirement applies to high school transcript. If
the application is for 2nd year or subsequent year of college, this requirement applies to
college grades only.
C. Applicant must demonstrate financial need for the scholarship.
D. Applicant must be pursuing a degree on a full time basis at an accredited college or
university. Award is not based on the applicant’s particular field of study.
E. The completed application form, along with all attachments must be post marked by
March 15, 2015 to the ESBOF Past Presidents Scholarship Committee at:
ESBOF Past Presidents Scholarship Awards Committee
C/o John J. Clancy
11 Shawsheen Road
Billerica, Ma. 01821
johnclancy16@yahoo.com
781-760-0183
Administrative Guidelines
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Applications can be obtained from organizations web site at www.esbof.org.
Every member of ESBOF will be e-mailed the scholarship information/
scholarship application no later than February 6, 2015. The applicant will no
longer have to request an application be sent.
Completed applications including all attachments must be post marked by March
15, 2015.
Selection(s) will be made by the ESBOF Past Presidents Scholarship Awards
Committee.
Financial Documents (IRS Form W-2) including parents (guardians’) and the
applicant are required to be submitted with the application. If the 2014 IRS
documents are not completed, then the 2013 documents are required to be
submitted.
Awards are presented at the Annual Conference Meeting/Luncheon (April 14,
2015). If the recipients are unable to attend, the scholarship award will be mailed.
Recipients must enroll within six (6) months of being awarded the scholarship and
provide evidence of attendance to ESBOF.
A student biography (including photography) must be included with each
application.
Acknowledgement
I had read the above guidelines, requirements, benefits and purpose and here-by
acknowledge and understand the process of the Scholarship Application procedures.
_____________________________________________________________________
Signature of Applicant
Name of Applicant
Date
Name of ESBOF Member /Sponsor
Eastern States Building Officials Federation
ESBOF Past Presidents Scholarship Awards
Applicants Name: ______________________________________________________
Address: _____________________________________________________________
Number and Street
____________________________________________________________
City/Town
State
Zip Code
Contact Information: ___________________________________________________
E-Mail Address
____________________________________________________
Phone Number
ESBOF Member/Sponsor: _______________________________________________
Name
Job Title: ______________________________________________________________
Jurisdiction: ___________________________________________________________
City/Town
Work Address: _________________________________________________________
Number and Street
_________________________________________________________________
City/Town
State
Zip Code
Contact Information: _____________________________________________________
E-Mail Address
_____________________________________________________
Phone Number
List all High Schools and Colleges you have attended:
Name of School:
Dates
Attended
Average (GPA)
Degree
Earned
Work History (Starting with the most recent employer):
Name
Address
Title
Dates Employed: _________________________________________________________
List all Extracurricular Activities (memberships in clubs, volunteer groups, sports teams, etc.)
Provide the following information concerning the college you are planning on attending:
Name
Location (State)
College Major Planned: ___________________________________________________
Year Scholarship will be applied (Ex: Freshmen, sophomore year): ________________
Tuition cost only: ______________________ per semester (do not include housing costs)
Applicant Statement:
In applying for consideration, I’m aware that the scholarship is to be applied to tuition only unless
otherwise specified. In the event that my tuition cost for the academic year does not equal the
amount of the scholarship awarded, I understand that I will receive only the amount of the tuition.
It is my intention to remain a full time student (as defined by the institution) for the term(s) for
which the scholarship is applied. I certify that all information submitted is true and correct to the
best of my knowledge.
Applicant’s Signature
Date
Confidential Statement of Financial
Applicant’s Name: _______________________________________________________
Identify below all sources of scholastic aid available to you during the school year for
which this application is being made:
A. Aid to be provided by parents:
$____________________
B. Personnel Savings, investments, trusts, etc.
$____________________
C. Earnings- current calendar year
$____________________
D. Social Security, Veterans benefits, etc.
$____________________
E. Other Scholarships, loans or grants for applied for
and expecting to be available for the upcoming
year.
$____________________
F. Aid from other relatives
$____________________
G. Other
$____________________
Total
$____________________
Parents Financial Information:
Information required from parent’s or parent most recent Federal Income Tax
Return (please provide/attach a copy of page 1 of the 2014 tax return, if not available,
please provide 2013 Tax return).
Number of Exemptions: __________________________
Number of Children in household who are attending college: _____________________
Adjusted Gross Income: ___________________________________________________
This information will be used to determine relative need for financial assistance and will
be kept strictly confidential by the Scholarship Committee.
ESBOF Scholarship Application Reference Form
Please complete and return this form by March 15, 2015. If the applicant is currently in
school or working, it is desired that the reference be completed by a teacher, guidance
counselor or an employer. If not in school or working, a personnel reference is
acceptable.
Recommendation for: _____________________________________________________
Applicant’s Name
Submitted by: ___________________________________________________________
Last name
First
Middle I.
Position Title: ___________________________________________________________
Address: _______________________________________________________________
Submit Form to: ESBOF Scholarship Committee C/o John Clancy, 11 Shawsheen Road,
Billerica, Ma. 01821. E-mail- johnclancy16@yahoo.com, Cell # 781-760-0183
1. What is your relationship to, or in what capacity have you come to know the
applicant?
2. What are some of the qualities of this applicant that lead you to believe he/she
merits a scholarship?
3. Are you aware of any personnel circumstances that might interfere with the
applicant success as a student or the utilization of the scholarship funds in a
suitable manner?
4. Additional comments.
Please feel free to attach your comments in a word document.
Name/Signature
Date
Eastern States Building Officials Federation
ESBOF Past Presidents Scholarship Awards
High School or College Transcript Request
The below named high school/college has my permission to release to my official
transcript to the ESBOF Past Presidents Scholarship Awards Committee
__________________________________
_________________________________
Name of High School/College
Name and Signature of Student
Instructions
High School/College officials are requested to complete this form, attach a copy of the
student’s official transcript and forward it to the scholarship committee. Transcripts must
be received on or before March 15, 2015. The mailing address is:
ESBOF Past Presidents Scholarship Awards Committee
C/o John J. Clancy
11 Shawsheen Road
Billerica, Ma. 01821
Please provide the following information, even if given on the transcript:
Students Name
Dates of Attendance:
______________________________________________________
From
To
Cumulative Grade Point Average (GPA): _____________________________________
College Entrance Test Scores-
CEEB/SAT: _________________________________
SAT: ______________________________________
ACT Composite: ____________________________
High School Class Size: __________________ Class Rank of Applicant: ____________
• If final results are not available, this should be based on latest information.
Name of School Official
Title
Student Biography
Each applicant is required to provide a biography, along with a small picture (wallet size)
of the student. Included in this bio should be the students goals, achievements, activities,
career objectives and list of schools applied to and/or accepted to. The bio should to one
to two paragraphs in length. This bio will be used for the ESBOF Annual Conference
Awards Program.
Student Picture