Scholarship Application Form – Martha's Vineyard Community Foundation

Which of the following applies to the applicant?*
- I will be graduating from the Martha's Vineyard Regional High School (MVRHS)
- I will be graduating from a secondary school other than the MVRHS
- I am currently attending a college/university or other post-secondary school/program

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Scholarship Fund Checklist
Please carefully review the description of each of these scholarship funds and select only those funds for which you qualify.
- Career Specific
- Katharine Harding Deeble/Landscape gardening, Environmental Science
- Harriet N. Goldberg Fund/Maritime
- The Joy Fund/Special needs student or Pursuing Special Ed Studies
- Mary I. Medeiros/Teaching
- Wendy Weisman Jenkinson Culinary Arts Fund/Culinary Arts
- Martha’s Vineyard Airport Commission/Aviation
- Harriet N. Goldberg Fund/Maritime
- Mary I. Medeiros/Teaching
- Wendy Weisman Jenkinson Culinary Arts Fund/Culinary Arts
- Martha’s Vineyard Airport Commission/Aviation
- Katharine Harding Deeble/Landscape gardening, Environmental Science
- Harriet N. Goldberg Fund/Maritime
- The Joy Fund/Special needs student or Pursuing Special Ed Studies
- Mary I. Medeiros/Teaching
- Wendy Weisman Jenkinson Culinary Arts Fund/Culinary Arts
- Martha’s Vineyard Airport Commission/Aviation
- Environment
- Thomas H. and Barbara F. Lee Scholarship Fund
- Albridge C. and Margaret Righter Smith Scholarship Fund
- General Education
- Beatrice Bennett Great Aspirations Memorial Scholarship Fund
- Walter and Irene Dumais Scholarship Fund
- Rusty Flack Scholarship Fund (St. Andrew’s parishioner, and/or Music)
- Anne Medeiros Kent Scholarship Fund
- Betty Ann Lima-Bryant Scholarship Fund/Community Service, Social Activism
- Inspiration Fund/Financial need, ELL, hardship on path to higher education
- Our Island Club
- Beatrice Bennett Great Aspirations Memorial Scholarship Fund
- Rusty Flack Scholarship Fund (St. Andrew’s parishioner, and/or Music)
- Anne Medeiros Kent Scholarship Fund
- Betty Ann Lima-Bryant Scholarship Fund/Community Service, Social Activism
- Inspiration Fund/Financial need, ELL, hardship on path to higher education
- Our Island Club
- Beatrice Bennett Great Aspirations Memorial Scholarship Fund
- Walter and Irene Dumais Scholarship Fund
- Rusty Flack Scholarship Fund (St. Andrew’s parishioner, and/or Music)
- Betty Ann Lima-Bryant Scholarship Fund/Community Service, Social Activism
- Inspiration Fund/Financial need, ELL, hardship on path to higher education
- Medical
- Dr. Clement R. Amaral and Vera E. Amaral Scholarship Fund/Dental Related Career
- Agnes Mello Fund/Medical studies, Nursing preference
- Dr. David Rappaport Memorial Scholarship Fund/Medical, Healthcare
- James S. and Violet M. Rego Scholarship Fund/PT, services to disabled
- Caroline A. Secor Scholarship Fund/Healthcare, Nursing priority
- George and Margaret A. Yates Memorial Scholarship Fund/Health related, pharmacy priority
- Agnes Mello Fund/Medical studies, Nursing preference
- Dr. Clement R. Amaral and Vera E. Amaral Scholarship Fund/Dental Related Career
- Agnes Mello Fund/Medical studies, Nursing preference
- Dr. David Rappaport Memorial Scholarship Fund/Medical, Healthcare
- James S. and Violet M. Rego Scholarship Fund/PT, services to disabled
- Caroline A. Secor Scholarship Fund/Healthcare, Nursing priority
- George and Margaret A. Yates Memorial Scholarship Fund/Health related, pharmacy priority
Other Funds
If applicable, the following funds will prompt for additional information while completing this scholarship form.
- Island Community Chorus Peter R. Boak Music Award
- Bagehot Backs Bursary for Building Skills / Trades, Craftsmanship
- Blankenship/Hughes Scholarship Fund / Essay "Improving Island Life"

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Applicant Information
Applicant's Name*
First Middle Last Suffix
Mailing Address*
Address Address Line 2 City State ZIP Code
Primary Email
Please enter your primary email address. A copy of your application submission will be sent to this address.
Additional Email Addresses*
Phone Number(s)*
Residential Address
- Same as mailing
*
Address Address Line 2 City State ZIP Code
Family Information
First Parent/Guardian Name*
First Last
Second Parent/Guardian Name
First Last
Parent/Guardian Address
- Same as above
*
Street Address Address Line 2 City State ZIP Code
Number of Siblings*
Age(s) of Siblings*
Number of siblings attending college or equivalent?*
How many years have you lived on Martha’s Vineyard?*
Please enter a number greater than or equal to 0.
Is English a second language for you?*
- Yes
- No
Are you the first member of your immediate family (parents and/or siblings) to attend college?*
- Yes
- No

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Secondary School Information
High School Attending*
- MV Public Charter School
- Other
High School Attended*
Name of Other School*
Date of Graduation*
School Phone*
Name of Guidance Counselor*
Class Rank Percentile*
GPA*
SAT Scores
Total Score
Evidence-Based Reading and Writing Score
Math Score
How many years have you attended high school at:
How many years did you attended high school at:
Martha’s Vineyard Regional High School*
Martha’s Vineyard Charter School*
Private Secondary School*
Home School*

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College/Program Information
Which of the following applies to the applicant?*
- I am presently enrolled in a post-secondary school
- I am presently applying to a post-secondary school
Name of school or program in which you are enrolled*
Major or Field of Study*
Name of school or program you are applying to*
Intended Major or Field of Study*
College/University or Other Program*
Name of the College/University or Other Program you plan to attend. If undecided, please list schools (at least three) in order of preference.
Type*
(choose one)
- 4 year college
- 2 year college
- Vocational/Technical School
Degree sought:*
Other Degree*
Upload Transcript*
Please attach a copy of your most recent transcript listing all coursework to date. Transcripts do not have to be official, but your name and student ID MUST be on them. Please upload and attach as a PDF. PLEASE NO LINKS!
Accepted file types: pdf.
Intended Field of Study or Major*
Year of Study in Fall 2020*
Other*
Anticipated Date of Graduation*
Admission Status at above institution:
Projected College Costs
Tuition*
Room & Board*
Other Expenses*

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Activities, Awards & Honors
List school and community activities you have participated in that were meaningful to you during the past two or three years.
Activities, Awards and Honors*
Activity # of Years Award/Honor/Position/Other
Work Experience
Employer Position/Description Dates Hours per Week Paid/Unpaid
Volunteer Experience
Organization Position / Description Dates Hours per Week
Career Goals*
Unique Circumstances
Please explain any unique family or personal circumstances that may have adversely affected your academic progress, community service or financial need.
Counselor Recommendation*
MVRHS Seniors: Please upload a recent letter of recommendation.
Accepted file types: jpg, gif, png, tiff, pdf, doc, docx.
Upload Transcript*
Please attach a copy of your most recent transcript.
Recommendation
All applicants are required to submit 1 letter of a current recommendation with their application. The letters must be completed by a non-family member professional reference, such as a teacher or counselor or advisor, an instructor, coach, or a work/volunteer supervisor with whom you have worked in the past year. Please provide the email address of your reference. They will be sent a link to the recommendation form, which they should submit under separate cover.
Upload Recommendation
Alternatively, if you have your recommendation form already filled out, you may upload it here.
Accepted file types: pdf, jpg.

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Choose from the following:*
- I am a dependent student.
  The data below represents my parents' finances
- I am an independent student.
  The data below represents my personal finance
First Parent/Guardian's Occupation*
Second Parent/Guardian's Occupation
- I choose to be evaluated on academic merit only.
Adjusted Gross Family Income*
Enter the amount of both parents/guardians' adjusted gross income from the most recent IRS filing. Include information for both parents if divorced and/or separated.
Untaxed Income and Benefits*
i.e., child support, social security, FDC, ADC etc.
Medical and Dental Expenses Not Covered by Insurance*
Total Family Savings Available for Applicant’s Education*
Total Applicant Savings Available for Education (include projected summer savings)*
Expected Family Contribution (EFC)
Please select the option applicable to you:
- Eligible and I have filed
- Eligible and I chose NOT to file
- Not eligible to file
Expected Family Contribution (EFC)*
This figure is calculated from the Free Application for Federal Student Aid (FAFSA) application available from the U.S. Department of Education.
Past Awards from the Endowment:
Fund Year Amount
List Amount of All Awards Received This Year*
Please Note: Depending on the funds selected, you may not be required to fill out information on steps 8-10. If they are not applicable, you will proceed directly to the last step of the form after clicking "Next"

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Island Community Chorus Peter R. Boak Music Award Applicants Only. Please provide the required information below:
CDs and Videos demonstrating talent are recommended. Please provide a web-link to your music video, send CDs demonstrating talent to the Permanent Endowment OR upload/attach any supporting files here.
Links to music or videos showcasing talent
Files
Drop files here or

Accepted file types: jpg, mp3, mov, pdf, png, gif.
Recommendations
Applicants must submit at least two completed recommendation forms, one from a music teacher or dramatic coach. Referents may not be related to the applicant.
Email (1)
Please provide the email addresses of your references. They will be sent a link to the recommendation form, which they should submit under separate cover.
Email (2)
Email (3)
Upload Recommendation Forms
Alternatively, if you have your recommendation forms already filled out, you may upload them here.
Drop files here or

Accepted file types: pdf, jpg.

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Bagehot Backs Building Skills Fund Applicants Only. Please provide the required information below:
Name of Major/Program/Course/Internship*
Description*
Location*
Dates*
Costs*
This fund is open to all residents of the Island. Preference may be given to descendants of those who worked in any capacity at Bagehot Backs, (the donor’s Island residence at 55 Oyster Watcha Road, Edgartown, MA 02539), but is not a prerequisite.
Purpose*
Please tell us why this educational opportunity is important to you and how it fits into your career goals.
Are you one of the descendants of those who worked in any capacity at Bagehot Backs, (the donor’s Island residence) at 55 Oyster Watcha Road, Edgartown, MA 02539?*
- Yes
- No
List*
Name of Qualifying Relation Their Profession/Trade Relationship to Applicant

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Blankenship/Hughes Essay*
The is an Essay Scholarship. Please submit an essay answering the question, “How can I help improve the quality of life on the Vineyard?” Essays should not exceed two pages.

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Personal Statement*
In one page or less, please tell us a little about yourself so we will know you better. If you are interested in a particular scholarship, share with us what makes you a good candidate.
*
- By checking this box, you certify all answers are truthful and accurate.
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Scholarship Form 2020

Step 1 of 11 - Graduating or Attending

Scholarship Fund Checklist

Other Funds

Applicant Information

Family Information

Secondary School Information

SAT Scores

How many years have you attended high school at:

How many years did you attended high school at:

College/Program Information

Projected College Costs

Activities, Awards & Honors

Expected Family Contribution (EFC)

Please Note: Depending on the funds selected, you may not be required to fill out information on steps 8-10. If they are not applicable, you will proceed directly to the last step of the form after clicking "Next"

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Name of Qualifying Relation	Their Profession/Trade	Relationship to Applicant

Activity	# of Years	Award/Honor/Position/Other

Employer	Position/Description	Dates	Hours per Week	Paid/Unpaid

Organization	Position / Description	Dates	Hours per Week

Fund	Year	Amount