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Georgia Association of Zoning Administrators
GAZA
P. O. Box 1041
Jasper, GA 30143-1041
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BETTY GECOMA SCHOLARSHIP APPLICATION
The Georgia Association of Zoning Administrators (GAZA) is pleased to award a $1,000 college academic scholarship each year to an entering Freshman or Upperclassman student who demonstrates superior academic achievements and has financial need. The scholarship is given in honor of Betty Gecoma, the founder of GAZA. The applicant must be an active GAZA member, or the child or grandchild of an active, retired, or deceased GAZA member. The scholarship will be awarded based on the information included in the application. Scholarship applicants may reapply for continued funding for up to a maximum of four (4) years, provided there is demonstrated academic progress and subject to review by the Scholarship Committee each year. Application submittals for the 2011-2012 academic year must be postmarked no later than April 1, 2011.
Name of Scholarship Applicant: ________________________________________________________
Please mark one of the following selections as appropriate:
( ) The applicant is an active member of GAZA.
( ) The applicant is a child or grandchild of an active, retired, or deceased GAZA member. If so, name of GAZA member: ______________________________________________________________
Student Applicant Information:
Full Name: ________________________________________ Birthdate: _____________________
Mailing Address: ____________________________________________________________________
City: _______________________________ State: ___________ Zip: ______________
Phone: __________________ Email: _______________________________________________
Are you currently enrolled in school? Yes No If Yes, full-time or part-time? ____________________
Name and city location of current school: _________________________________________________
Latest reported grant point average from this school: _____ During which term? __________________
Latest reported test scores (as applicable): SAT __________ ACT _____________
Year in school during current academic year (freshman, sophomore, etc) ________________________
Are you currently employed? Yes No If Yes, where? ____________________________________
Honors received: ____________________________________________________________________
Memberships (clubs, fraternities, other extracurricular activities): ______________________________
__________________________________________________________________________________
Hobbies / Interests: __________________________________________________________________
__________________________________________________________________________________
List other financial sources for educational / living expenses, and note approximate annual amounts:
__________________________________________________________________________________
__________________________________________________________________________________
Parent or Legal Guardian Information: (if applicable)
Name(s): __________________________________________________________________________
Mailing Address: ____________________________________________________________________
Telephone: __________________ Email: _______________________________________________
Place of Employment: ________________________________________________________________
College or University Information:
Name of School and City Location: ______________________________________________________
Intended field of study or major: ________________________________________________________
Payment Information:
If the scholarship were awarded to you, which of the following payment options would you prefer (Please circle one)
1. Multiple check payments (either semesterly or quarterly), made payable to the student only.
2. Multiple check payments (either semesterly or quarterly), made payable jointly to both the student and school together.
3. Lump sum check payment made payable to the student.
4. Lump sum check payment made payable jointly to both the student and school together.
Where should the check(s) be sent? Name & Address: ___________________________________
___________________________________
___________________________________
Attachments:
Please attach each of the following items with this application.
A. Copy of most recent transcript or grade report (high school or college).
B. Typed essay of between 100 and 500 words which answer the following questions:
“What are your career interests in Life? How does this determine your field(s) of study? And, why have you chosen these?”
I / we hereby certify to the best of my knowledge that all the information depicted on this application (including all attachments) is true and accurate. I / we agree that use of the scholarship funds shall be for enrollment or continuance of education in a recognized and / or accredited school such as a college, university, trade or technical school, business college, or others as may be approved by the Scholarship Committee. The funds shall be used for such purposes as tuition fees, books, school supplies, and other expenses while enrolled in the school.
__________________________________________ ___________________________________
Student Date Parent or Legal Guardian Date
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