First and last name

Include your street address, city, state, and zip code.

Include a phone number and email.

Please indicate whether you are currently a:

If you select yes, check the other box and include the title of the course and the cost.

If you are currently not attending high school or a college/university, type: N/A

List your current GPA and the scale. Please use the following format: GPA/Scale (e.g. 3.5/4). If you are currently not attending an academic institution, type: N/A

Please the list the college or university you have been accepted at, or indicate that you have not yet been accepted or decided where to attend.

Do NOT list your high school student ID. Please indicate if you have not yet been accepted or decided on an academic institution.

Please list your major field of study or indicate if you are undecided.

If you answer "yes," list the dates and amounts in the "other" section.

List awards, other scholarships, honor societies, honor roll, Dean's list, publications, special recognitions received, etc. with dates and a brief description.

If you check Fairfax County Public Library and/or Fairfax Library Foundation, please answer question the question on employment details. If you checked "none of the above" skip the question on employment details.

Please list the branches or facilities at which you worked, the number of years employed, whether you were full or part time, and a description of your duties.

If you answer Fairfax county Public Library, Fairfax Library Foundation, or Friends of the Library group, please answer the question on volunteer details. If you choose none of the above, skip the question on volunteer details.

Please list the branches or facilities at which you volunteered, the number of years volunteering, the total number of hours volunteered, and a description of your duties.

List part-time and full-time jobs, internships, volunteer jobs, etc. covering the last three years, excluding descriptions from items 14 through 17. Include details on the employer, dates worked, hours per week, and description of work.

Include family/at home responsibilities such as care of a family member or relative, student activities, sports, religion-related programs, community service programs, committees, art, music, etc.). List the activity or responsibility, description of duties, dates of activities, and the hours per week.

In your own words, please explain why you want to obtain a higher education and how receiving this grant would make a difference for you. What difficulties and challenges do you face in obtaining this degree? How will the courses you are taking prepare you for the future you envision for yourself? How have libraries contributed to your growth and success in your studies?

Please email or have the individual writing your reference letter email the letter to Shelby.Allen@FairfaxLibraryFoundation.org no later than January 15, 2022.

An unofficial transcript is acceptable if it identifies the issuing authority and your cumulative GPA. Please email your transcript to Shelby.Allen@FairfaxLibraryFoundation.org no later than January 15, 2022.

If I am awarded an undergraduate scholarship, I understand that funds will not be disbursed until I have actually been accepted or enrolled in the course or program described above and I have registered for any volunteer service hours I am required to perform. I agree to complete the covered course work and volunteer service as required by the next scholarship application deadline or repay up to the full amount of this scholarship award. I agree to submit a copy of my transcript (official or unofficial) or other grade report within 14 calendar days of completion of the term, semester, or course/s as required by the Foundation. I authorize the use of my name, photograph, and narrative excerpts to promote the Fairfax Library Foundation’s Scholarship Program. I understand that Fairfax Library Foundation decisions are final and not subject to appeal. Please type your full name if you agree to the terms above.