Hanover County Public Schools

Need Based Scholarship Addendum


Name: Social Security #:

Parents' Gross Income as reported on last tax return:

(The Scholarship Committee is sensitive to the parents' need for confidentiality concerning financial information.)

Names of brothers and sisters and their ages:

Is there anyone else living in the home dependent upon your parents' income?     YES     NO

Name of institution you plan to attend:

Anticipated cost of tuition, board, books, etc.:

Have you applied for Financial Aid:     YES    NO

What is your vocational goal at this time?

Will you be contributing to your college expenses? YES NO

Are you seeking summer employment?     YES    NO

Have you applied for any other scholarships or will you be receiving any other assistance?

   YES    NO

If so, please list:

Student's Signature

Parent's Signature (if student is under 18)