Berks County Community Foundation-Clymer Application

The Helen M. Clymer Scholarship Application
One or more scholarships will be distributed annually to single mothers who are residents of Berks County who are furthering their education at a 2-year or 4-year college or university located in Berks County.

For the purposes of this fund, a single mother is defined as a woman who has sole guardianship for one or more natural children. One or more of her children must be 17 years of age or younger in order for the mother to receive awards from this fund.

To be considered for this scholarship, complete and submit the following
form electronically between January 15 and April 1.

In addition to submitting the form below electronically, you must mail in the following attachments postmarked no later than April 1. Put your name on all submissions:

One letter of recommendation from someone who is not related to you. This letter should be from a teacher, school official, employer, advisor, community leader or other person who knows you well.
A copy of your high school transcript.
A copy of your transcript from any post-secondary institution you've attended.
An acceptance letter from the school you will attend.

Mail the above information to:
Helen M. Clymer Scholarship
Berks County Community Foundation
P.O. Box 212
Reading, PA 19603-0212

Please fill out the form below and submit electronically by April 1:

Applicant Name:

Prefix

First

MI

Last

Suffix

Street Address:

Address 2 (optional):

City:

State: Zip Code: County

Home Phone Number:

Email address:

What is your marital status?

Where did you go to High School?

High School Graduation Date:
Do you have a G.E.D.?:Yes No
If yes, when did you earn your G.E.D.?

About Your Parents
Complete this section if you are under 21 years of age.

Father, stepfather or male guardian's name (if you are under 21 years of age):

Father's Address (if different from above):

Father's Occupation and Employer:

Mother, stepmother or female guardian's name (if you are under 21 years of age):

Mother's Address (if different from above):

Mother's Occupation and Employer:

About Your Children
Provide the names and birthdates of the children for which you have sole guardianship:

Post-Secondary Plans

What educational institution are you planning to attend?

What is your intended major?

What is your intended career?

Will you attend school:Part time Full time

Expected cost of tuition, etc. per year:

Have you received or do you anticipate receiving any scholarships? If yes, please indicate which ones and the amount of each (do not include loans):

Activities, Awards and Honors
List all community activities in which you have participated in the past four years:

Employment:

Current or most recent employer:

Dates:

Employer:

Position:

Reason for leaving (if applicable):

Previous employer:
Dates:

Employer:

Position:

Reason for leaving:

Please attach a one-page essay in Microsoft Word or PDF format that describes why you qualify and have a need for a scholarship from this fund:

How did you hear about the Community Foundation?

Note: Berks County Community Foundation employees, board members and/or committee members are not eligible to apply or be nominated for a grant or scholarship, nor are their immediate family members. Immediate families include spouses, children, stepchildren, grandchildren, and stepgrandchildren. The ineligibility period for Berks County Community Foundation board members or employees extends five years after board service or employment terminates. The ineligibility period for committee members who are not Berks County Community Foundation board members or employees is in effect only during their term of service.