~ 1 ~
Please be certain to include:
Your completed application
Your essay
A transcript of your grades
SCHOLARSHIP APPLICATION
Applicant Name:
School Planning to attend:
Each year VyStar Credit Union awards a student of each VyStar Academy of a scholarship. Eleven
scholarships will be awarded for the upcoming 2016-2017 college school year. Each scholarship will be
in the amount of $1,000 and will be awarded to each of the eleven VyStar Academies. The following
qualifications will apply:
1. The applicant must have been a student of VyStar Academy during the 2016-
2017 school year.
2. The applicant must be a Senior at their respective high school.
3. The applicant must be ready to enroll in an accredited college/university for the Fall 2017
school term.
To receive a scholarship, if awarded, the student must remain in good academic standing, graduate from
their respective high school at the end of the school year, and attend their stated college within one year
of the awarding of the scholarship.
Applications will only be considered complete if
ALL
required documentation; including transcripts; are
postmarked on or before the deadline.
All applicants will be notified of their status. Awards will be
announced in June. After receipt of student confirmation of enrollment, scholarships will be disbursed
through Financial Aid offices. Funds must be applied first to tuition, books, and lab fees. After the
drop/add deadline, the remainder of the scholarship dollars may be released to the recipient.
RELEASE FOR PURPOSE OF RECEIVING A SCHOLARSHIP:
If awarded a scholarship, I grant VyStar Credit Union the right to utilize my name and likeness in
all manner and media. I hereby waive any right or claim inspection or approval of any publication
in connection with this use.
Signature: Date:
Application and all supporting documentation must be postmarked on or before MARCH 31, 2017 and mailed
to:
Ken Dellmire
Vice President Product Development
VyStar Credit Union
P.O. Box 45085
Jacksonville, FL 32232-5085
~ 2 ~
Please be certain to include:
Your completed application
Your essay
A transcript of your grades
SCHOLARSHIP APPLICATION
Questions regarding this application may be directed to
Ken Dellmire, via phone (904) 908-2711 or
via email dellmirek@vystarcu.org. (Please Print)
Name:
Current Address:
City, State, Zip:
Permanent Address:
City, State, Zip:
Phone #s: Home: Work: Cell:
E-mail address: Social Security #:
Date of Birth: Marital Status:
If non-citizen, what type visa do you hold?
Give name, relationship, & occupation of anyone who claims you as a dependent for income tax purposes:
Current High School: GPA: Anticipated Graduation Date:
College planning to attend next fall: Admitted?
Goal: Degree(s): Expected completion date:
Major Minor
Subsequent Plans:
Work Experience (List current employer first). Attach additional page if necessary.
Employer
Position
Dates
Hrs/wk
Earnings/wk
~ 3 ~
Please be certain to include:
Your completed application
Your essay
A transcript of your grades
SCHOLARSHIP APPLICATION
List non-school, non-paid, and non-family activities of the past 4 years (hobbies, volunteer work,
organizations)
Type of Activity
Time Spent
Honors/ Awards/Offices Held
Please check the VyStar Academy from which you are applying.
Bartram Trail High School
Orange Park High School
Fleming Island High School
Palatka High School
Pedro Menendez High School
Matanzas High School
Ribault High School
West Nassau High School
Wolfson High School
First Coast High School
Middleburg High School
All applicants must write a short essay, to be attached and submitted with their application. The
topic of this essay is described below:
Describe the life factors that have caused you to select your current educational and career path.
How will the degree you seek impact your life?
CERTIFICATION: I hereby certify that all information contained in this application is true and correct
and that the essays are my personal work and creations.
Signature: _________________________________________________ Date: ___________________
