Use Blue or Black Ink and Print Legibly Must be Received byDue Date: April 15.2014

DAVID MORRIS MEMORIAL SCHOLARSHIP APPLICATION

First Name Middle Name Last Name:

Permanent Address,

Telephone No.

Maiden Name

Date of Birth .Social Security No._

Marital Status: (S-singleTM-Married,D-divorced)

Number of other children supported by applicant's parents

Financial Information

(If married give information on self and spouse)

Name

Address

Occupation

Employer

Annual income (all sources)

Father or Guardian or Self Mother or Guardian or Self

High School AttendedGraduation YearHave you taken ttie ACT?_Have you taken the SAT?_

Rank in class

_Total Score,Total Score

_MathMath'

_EnglishVerbal

College you plan on attendingAddress of CollegeHave you applied for admission?What will be your college majar?_

_Have you been accepted?._Full or part-time college student?^

List any scholarships, grants, loans, or other sources of income you wilt be receiving write attending school

Loans

Grants

Scholarships

Gifts/Other

Source Amount per year

I you live at home or at school?_

Will you own or have a car to use at school?_

Do you plan to work while attending college?_

Make and Model

Part-time of Full-time?

Work Record

Place of Employment Hours per week Employment term

List three references:Name Address Telephone

NOT&AM requested information must be famished in order to be considered. Please attach a letter stating

your background, your plans, and goals: as wett as any other informatioB which you wish teindude, YOB

should also submit a copy of your hiph school transcript or tf applicable, a copy of your college transcripts,

Letters of Recommendation from educators, cterov. eflmtovere. etc. are optional but welcome.

You will be notified if you are selected for a scholarship. You will not be informed of non-selection.

Signed(Applicant)

Parent's StatementI acknowledge that I have read, understand and agree with the application information that my son/daughter has submitted.

Date: Signed:.

(Parent Signature)

Mail application to:

David Norn's Memorial Scholarship Fund2753 CR 2040Ravennajexas 75476

David Norris Memorial ScholarshipNomination for Scholarship

Educator, Employers of youth, Clergy,etc. may use this form to submit nominations forprospective scholarship recipients. It is requested that your nomination be limited to thosestudents who, in your opinion, have a financial need and who have a good potential tosuccessfully complete their course of study. Also, nominees should be individuate who areexpected to conduct themselves in a manner so as not to bring discredit to ttTecnseives or theircommunity.

Name, Birthdate Graduation Date

Address State TEXAS Zip

High School Attended

Student Plans (if known)

Please rate your nominee on the following factors: (Scale t-10 with f being the fowest)POTENTIAliNITIATIVE _ SCHOLASTIC ABILITYATTITUDE CITIZENSHIPMOTIVATION _

What is your nominee's strongest attributes?

In what area does your nominee have room for improvement?.

Comments:

Your Name TitleYour Address Date

Mail this form to:David Norris Memorial Scholarship Fund2753CR2d4dRavenna Jexas 75476