Jessamine S. Henderson Memorial
Adult Education Scholarship Fund Application
Address Line 2
Are you a high school graduate. If so what year?
Have you received a GED, if so what year? Insert N/A if applicable.
Name of any schools you may have previously attended including dates and degrees or certificates awarded.
What School (s) are you currently attending?
What School do you plan on attending and when?
What course of study or training do you plan to pursue?
Certificate or Degree you expect to receive and expected date of completion?
Number of individuals in your household?
Number of individuals currently attending college or other post-secondary school programs?
Are you currently employed?
If yes for how long?
Average of hours generally worked each week.
How much do you anticipate your continuing education to cost each year?
From all sources
, how much do you anticipate being able to contribute to your continuing education each year?
Please provide the names of 3 individuals (not relatives) as references including contact information and years known.
Please write a short statement about your education and goals including why you are furthering your education, how do you plan to use your education and are there any special circumstances that should be considered?
I have completed the Free Application for Federal Student Aid (FAFSA) and may be required to furnish it to JSH Fund. If FAFSA Is not available information regarding income/living expenses and cost of education if requested.
I hereby authorize the JSH Fund to publicize my name, picture and any scholarship I receive. I authorize the JSH Fund to examine my educational and financial aid records for scholarship purposes. I certify that all information provided in this application is accurate.
I understand that the JSH Fund may withdraw my award due to unmet scholarship criteria and/or fund availability and that any scholarship I may be granted must be used within 180 days of the date of the award. I certify that I am currently a resident of either Somerset or Hunterdon County, NJ. I understand that I will forfeit any scholarship award if I move from Somerset or Hunterdon Counties, NJ.
Please sign below.
Date of Application