Multiple Scholarship Application Form The Canterbury Technical Academy Scholarship application window for the 2016-2017 school year is now open to new students. If you or your student is interested in attending Canterbury Technical Academy, fill in the form below to apply for all available Canterbury Technical Academy and Wake scholarships. These scholarships are eligible for use at Canterbury Technical Academy only. NOTE: Several Canterbury and Wake scholarships require that the student completes an essay to be eligible for an award. While you are not obligated to complete the essay on this application for all scholarships, we recommend completing this section if possible to increase your likelihood of receiving a sufficient award. Student Academic Status New Student Current Student Returning Student Programs of Interest Day Programs Night programs Home programs Drop Back In If awarded a partial scholarship, what monthly copay amount could you afford? Please select an amount. (Required for processing) $0 (No copay) $10-50 monthly $51-100 monthly $100-200 monthly $201-300 monthly $301-400 monthly (Selecting a higher value will not reduce your award amount. Scholarships are not awarded if the total copay amount is substantially greater than the recipient's budget.) Student First Name Student Last Name Student Date of Birth Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country Afghanistan Albania Algeria Andorra Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands and Niue Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Primary Phone - - Email Preferred Method of Contact Phone Email Mail Student Gender Male Female Current Grade 5th 6th 7th 8th 9th 10th 11th 12th Last School Attended In public school, was the student eligible for free or reduced lunch? Yes, Free Lunch Yes, Reduced Lunch No Yearly Household Income Below $15,000 Below $25,000 Below $35,000 Above $35,000 Has the student been diagnosed with any disabilities. Yes No If yes, please explain Has the student ever recieved special educational services. Yes, The student has an IEP Yes, but the student does not have an IEP No Current / Last known GPA 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 Referred / Recommended by: Does the student participate in any of the following? (Check all that apply.) Basketball Team Football Team Student Governement Robotics Team Math Club JROTC Chess Club Book Club Will the student be working while taking classes? Yes No If you are employed, where do you work? Would the student be interested in any work study scholarships? Yes No Does the student currently receive any other financial aid? Yes No Submit A Student Essay: 250-500 words (5,000 characters maximum) The statement should include the following: • Reasons you selected Canterbury Academy • Reason(s) you feel that you that you should receive a scholarship. • Benefits you've received from any community service experience you have had. • Contribution you feel you can make or are making as a Canterbury Academy student. In the last year, has the student maintained honor roll? Yes, A Honor Roll Yes, A/B Honor Roll No In the last two years, has the student been suspended/expelled? Yes No If so, why? Has the student ever been expelled? Yes No What do you plan to do after high school? Do you have anything else to add? Submission of this form constitutes my signature. Today's date is: / /