Please complete only ONE application and ONE set of attachments.

Please read the enclosed list of scholarships available

for 2014-2015 and check off all funds for which you are eligible. CURRENT RECIPIENTS OF RENEWABLE
FOUNDATION SCHOLARSHIPS MAY NOT REAPPLY.
his application must be completed by the student. Assistance from parents/guardians should be limited to the
Statement of Family Income and Resources.
Unless another geographic area is noted, scholarship recipients must be residents of South Hampton Roads
(Chesapeake, Norfolk, Portsmouth, Virginia Beach, Suffolk, Isle of Wight County) who are graduates of a local high
school or are non-traditional age students who are long-time residents. Out-of-town students attending a local university
are not eligible.
Priority for undergraduate scholarships will be given to applicants enrolling in a bachelor's degree program at a
nonprofit, college or university in the United States that participates in Federal Student Aid Programs (Title IV)
unless otherwise noted. Recipients must enroll full-time in a degree program; non-degree candidates are not eligible
to receive funds. Scholarships are not available for vocational and technical diploma or certificate programs unless
otherwise noted.
Most Foundation scholarships require financial need. You must file the Free Application for Federal Student Aid
(FAFSA) and submit and copy of your Student Aid Report (SAR) with this application.
Please read the application carefully before completing. Special instructions regarding letters of recommendation,
transcripts and the Statement of Family Income and related financial documents are on the Application Checklist located
on the back page of the application. Do not forget to sign your application and the Statement of Family Income and
Resources.
Please TYPE or PRINT IN BLUE OR BLACK INK. Do not staple or bind your application and attachments.
Your application and all required attachments must arrive in our office on or before FEBRUARY 28, 2014. This is
NOT a postmark deadline. Late, incomplete, e-mailed and faxed applications WILL NOT be considered.
Applications may be hand-delivered to our office on the 4th floor of the World Trade Center building in downtown
Norfolk (Mon.-Fri., 9am-5pm) or mailed to Hampton Roads Community Foundation, 101 W. Main Street, Suite
4500, Norfolk, VA 23510. Remember to mail your application in time to arrive by the deadline and affix the
correct postage to the envelope based on its weight and dimensions. The Post Office will return items with
insufficient postage to the sender which may result in your application missing the deadline.
Please be sure to regularly check the e-mail address you provide on the application. We may attempt to contact you by
e-mail if there is a problem with your application.
Award amounts for most funds are not predetermined; they depend on the amount of funds available, the number of
winners selected and individual financial need. The average scholarship in the 2013-2014 school year was
approximately $2,800.
The Foundation attempts to send decision letters in mid-April before students must commit to their chosen colleges.
The Foundation receives approximately 500 applications and cannot confirm receipt of applications and supporting
documents by phone. If you would like to verify that your completed application was received, send an e-mail to
scholarships@hamptonroadscf.org.

If you have questions about completing your application, call our office at 757-622-7951 and speak to Ms. Robin Foreman, Vice
President of Scholarships & Administration, or send an e-mail to scholarships@hamptonroadscf.org.

RELATIVES OF THE HAMPTON ROADS COMMUNITY FOUNDATION BOARD AND STAFF ARE NOT ELIGIBLE TO APPLY.

RELATIVES OF THE DONOR(S) WHO CREATED A SCHOLARSHIP ARE NOT ELIGIBLE FOR SCHOLARSHIPS FROM THAT FUND.
Name
Scholarships Available for 2014-2015
Application Deadline: February 28, 2014

Students must be from South Hampton Roads unless otherwise noted.
Scholarships are for full-time education at a four-year college unless otherwise noted.

UNDERGRADUATE SCHOLARSHIPS - visit www.hamptonroadscf.org/scholarships for full descriptions
Jesse T. Bonney Memorial - For female Virginia residents under the age of 26.
Preference will be given to students from South Hampton Roads. $
Clara W. Burhans Memorial - For deserving students from Norfolk, Virginia
Beach or Chesapeake. $
Charles F. Burroughs - For students attending Hampden-Sydney College.
Peninsula and Eastern Shore students may apply. $
J. Robert & Ettie F. Cunningham Memorial - For students from Norfolk with a
preference for those pursuing a career in education. $
Frank Fang Memorial - For Chinese or Chinese-American students from
Hampton Roads (including Peninsula and Gloucester Co.) This award is merit-
based; financial need is not a factor. This is a one time award and is not
renewable.
Harry Bramhall Gilbert Memorial - For Chesapeake Public Schools graduates
attending William & Mary, JMU, UVA or Virginia Tech. This award is merit-
based; financial need is not a factor.
Victor and Ruth N. Goodman Memorial - For vocational or upper-level
undergraduate students studying medicine or other health professions. $
Friends of Joshua P. Darden, Jr. - For students graduating from public schools
in South Hampton Roads. $
Col. J. Addison Hagan Memorial - For students attending Virginia Military
Institute. Peninsula and Eastern Shore students may apply. $
Joseph E. & Bertha White Harry - For students attending Old Dominion
University or Virginia Wesleyan College. $
Adrian Ryan Kirk - For a graduating high school senior with ADD, ADHD or
learning disabilities pursuing college or vocational education. This award is
merit-based; financial need is not a factor. This is a one time award and is not
renewable.
Margarette Hanes Old - For students attending Salem College in Winston-
Salem, NC. $
Carrie Biggs Morrison Memorial - For students from Virginia Beach. This award
is merit-based; financial need is not a factor.
The Pender Scholarship - For female students attending the College of Notre
Dame of Maryland. Peninsula and Eastern Shore students may apply. $
Ellen Hitt McLaughlin - For a graduating high school senior who attended
Holland Elementary School in Virginia Beach for at least one year. This is a one
time award and is not renewable. $
Indicate years attended:
through
Elisabeth Kelly King Reilly Memorial - For Maury High School graduates
attending the University of Virginia. $
Ellis W. Rowe - For students from Gloucester County. $
Wilfred G. Semple Scholarship Loan - For college juniors or seniors studying
engineering, physics or math at a Virginia university. $
Edwin J. Rosenbaum - For students of the Jewish faith. $
Jarrod Camper Smith Memorial - For a graduating high school senior who
participated in youth sports at King's Grant/Lynnhaven Recreation Association
for at least three years. This award is merit-based; financial need is not a factor.
This is not renewable.
Enid W. & Bernard B. Spigel Architectural - For undergraduate students from
Virginia who are juniors or seniors majoring in architecture, architectural
history or architectural preservation. $
D.A. Taylor Memorial - For students displaying qualities of strong leadership,
academic abilities, extracurricular involvement, a commitment to helping
others and overall excellence inside and outside of the classroom. $
Thomas P. Thompson - For Norfolk Public Schools graduates. $
Yeonas Memorial - For students of Greek descent attending community or
four-year colleges or students attending Old Dominion University. $
Check all funds for which you would like to be considered.
$ = Financial need required; must submit Statement of Family Income and Resources with application
= Only one scholarship will be awarded
If a scholarship is not listed it is not available for the upcoming academic year or the recipient must be nominated.
Pat Howe Jr. Health Care - For students from Hampton Roads (including the
Peninsula) studying nursing, physical therapy, radiography or other allied
health professions in a post-secondary certificate, diploma or degree program
at a nonprofit school in Hampton Roads. Applicants must have completed at
least half of their program requirements (e.g., credits, semesters). $
Ocean Lakes - For students graduating from Ocean Lakes High School who will
major in science, technology, engineering or mathematics. Preference will be
given to students who have taken AP Calculus and have at least a 3.5 GPA. $
Julia Atwater Bristow - For graduates of public schools in Norfolk and on the
Eastern Shore of Virginia to attend secular colleges. $
James 2:26 - For students attending public Virginia colleges with a preference
for residents of public/subsidized housing. Recipients must live on campus for
their freshman year. $
Roland W. Proescher Scholarship- For students studying engineering,
medicine, dentistry, pharmacy or other science. $
Minton W. Talbot - For students graduating from Granby High School. $
Capt. Rexford V. Wheeler Jr. USN - For students from South Hampton Roads
attending Old Dominion University. Preference is for Norfolk residents. $
Community Fund/Brockwell/Morgan/Price/Sharp - For deserving students
from South Hampton Roads. $
Diana Reilly Hartzog Memorial - For a graduating high school senior with a
preference for those pursuing majors in library science or English. $
Tommy Horvatic Memorial - For students graduating from Princess Anne High
School attending community or four-year colleges. Students must demonstrate
good character and community service. $
Walter Cecil Rawls Educational Fund - For students graduating from public
schools in Franklin, Suffolk, Sussex County, Isle of Wight County, Southampton
County and Gates County, NC to attend college or certified vocational
programs. Two students will be selected from Suffolk. One student will be
selected from each of the other localities. This is a one time award and is not
renewable. $
E.W. Chittum Memorial - For students graduating from a Chesapeake Public
School with a preference for those who will attend Washington & Lee. $
Thomas G. Johnson Jr. - For Norfolk Public School graduates attending the
University of Virginia. $
Jennifer Mooney Greene - For Virginia Beach Public School students who are in
the AVID program and have limited family history of attending college.
Preference will be given to students from Green Run High School. Applicants
must submit a letter of recommendation from the AVID coordinator. $
Judge Floyd E. & Annie B. Kellam Scholarship - For students graduating from
Kellam High School pursuing degrees in math, science or business at a
community college or four-year college. $
Hampton Roads Spartan Scholarship - For students from South Hampton
Roads attending Norfolk State University. Preference is for single parents. $
Lewis K. Martin II, M.D. and Cheryl Rose Martin - For a Virginia resident
attending Davidson College, Salem College or Salem Academy in North
Carolina. $

Provide highest test scores here. Scores must also be included on
your high school transcript or a copy of your score report(s) must
be submitted with this application.

SAT Scores:

If you have not taken the SAT, please provide your composite


College/School of Choice
If undecided: 2nd Choice
Accepted Wait-listed Pending
Accepted Wait-listed Pending
Accepted Wait-listed Pending
2014-2015
Undergraduate
Scholarship Application

Name
First Middle Last
Date of Birth
Citizenship:
U.S. Citizen U.S. Permanent Resident (Citizen of )
How long have you been a resident of:
Answer for applicable region(s) yrs. yrs. yrs.
Hampton Roads Virginia Gloucester Co.
Address
City State
Zip
3rd Choice
In the fall I will be a:
Freshman Sophomore Junior Senior 5th Year Senior
I plan to live:
On-campus housing Off-campus rental Home with family (commuting)
High School From Which You Will Graduate or Have Graduated City and State Dates Attended
List Any Colleges You Have Attended City and State Dates Attended
See the checklist provided on page 4 for instructions on sending official transcripts.
Critical Reading/
Verbal Math Writing
ACT Score
ATTACH
PHOTOGRAPH
(Optional)
Intended Major
Expected Graduation Date
Phone
Number
Nickname/Preferred Name
Suffix
E-mail

Name
List EXTRACURRICULAR activities in which you have participated (e.g., clubs, sports, scouting, band, teams, societies, private music, dance
or martial arts study/competition, Upward Bound, etc.)
Activity
If you are currently an undergraduate, list high school AND college
activities.
Positions Held and Honors/Awards Participation by Year

Fresh Soph Jr Sr College
Example: Student Council class rep (2011); VP (2012) X X X
List COMMUNITY SERVICE activities in which you have participated. (e.g., hospital volunteer, tutoring, etc.)
ACTIVITIES (You may attach ONE additional sheet if necessary.)
Select the community service or leadership activity most important to you. Describe it in detail and explain why it is important to you.
(Use only the space provided.)
List any jobs you have held during the last three years.
Position Held/Type of Work Employer Dates of Employment No. of Hours Per Week
Page 2 of 4
Organization Role/Responsibility
Hours Per Month Total Hours Fresh Soph Jr Sr College
What high school or college course has had the greatest impact on you? Explain why. (Use only the space provided.)
In 20 words or less, what sets you apart from other students?
PERSONAL STATEMENTS & SPECIAL ATTACHMENTS
A. Please attach a typed response that addresses both of the following topics: (Two pages maximum)
1) What are your educational and career goals? (Include why you chose your field of study, career path and college.)
2) Pick an obstacle you've overcome or a significant experience from your life. Explain how it has affected
the way you see the world and who you want to be.

B. If you would like to be considered for the scholarships available to Greek, Chinese or Jewish students, attach an
additional statement describing your activities in the local Greek, Chinese/Asian or Jewish community and any pertinent
information about your family history that you would like to share. Review the scholarship checklist to determine if the applicable scholarship
is available this year before completing this extra essay. (Two pages maximum)

C. If you would like to be considered for the Jarrod Camper Smith Memorial Scholarship, attach an additional statement describing
what your participation in King's Grant/Lynnhaven Recreation sports has meant to you. How has it impacted your life so far, and what
influence do you feel it will have on the rest of your life? Also list the sport(s), years you participated and, if possible, team names and
coaches. (Two pages maximum) NOTE: Lynnhaven Baseball is NOT a part of King's Grant/Lynnhaven Recreation Association.

D. If you would like to be considered for the Adrian Ryan Kirk Memorial Scholarship, attach an additional statement that addresses
how your learning disability, ADD and/or ADHD has influenced you in school and your future career goals, how you anticipate dealing
with these issues in the future, and why you think you should be awarded this scholarship. (Two pages maximum)
ATTACH THE ELIGIBILITY PAGE FROM YOUR IEP, SECTION 504 OR OTHER DOCUMENTATION INDICATING THAT YOU HAVE A DISABILITY.

E. If you would like to be considered for the George D. and Marion Phelps Hamar HRBOR Scholarship for LGBT students, attach an
additional statement describing your community activities and contributions to the lesbian, gay, bisexual and transgender communities
and anything else you would like to share about your experience with LGBT issues in your school or Hampton Roads. Please note: a list of
scholarship recipients will be provided to your high school and published annually in the Foundation's newsletter. You must be
comfortable with having your name publicly affiliated with this scholarship. Review the scholarship checklist to determine if the scholarship
is available this year before completing this extra essay. (Two pages maximum)
I certify that all information furnished in this application is true and complete to the best of my knowledge. I agree to abide by the criteria of any
scholarship that may be awarded. I authorize Hampton Roads Community Foundation to obtain verification of my enrollment status or
financial aid information from the aforementioned college or university of choice as needed for the processing of this application.
NAME (print)
Page 3 of 4
SIGNATURE
DATE
PARENT'S SIGNATURE
PARENT'S NAME
(print)
DATE
Parent or guardian's signature is also required if the student is under the age of 18
Hampton Roads Community Foundation must adhere to all legal eligibility criteria established by scholarship fund donors as to the race, age, gender, religion and ethnicity of
scholarship recipients. Beyond those donor-prescribed criteria, the Foundation does not discriminate on any illegal basis in administering its scholarships.
Name
Page 4 of 4
APPLICATION CHECKLIST
Carefully read the cover letter and the application. Make sure your application package is complete and accurate. Return the
application by the deadline to: Hampton Roads Community Foundation, 101 W. Main Street, Suite 4500, Norfolk, VA 23510.
If you have questions about the application, please call (757) 622-7951 or send an e-mail to scholarships@hamptonroadscf.org.
If you wish please attach a small photograph. A snapshot or photocopy of a picture is acceptable; a professional photograph is not necessary.
Since the Foundation does not conduct interviews, this helps the Scholarship Committee match a face with the person we are getting to know
on paper.
Personal Statement A - Please address BOTH questions. All applicants must provide Personal Statement A. (NO MORE THAN TWO PAGES)
Personal Statement B, if applying for Yeonas, Polizos, Georges, Fang or Rosenbaum scholarships (NO MORE THAN TWO PAGES)
Two letters of recommendation mailed directly to the Foundation by the persons making the recommendation or submitted with
Name of Recommender
Letter enclosed
Letter to be mailed directly
Name of Recommender
Letter enclosed
Letter to be mailed directly
Official transcripts from high school and college
Private school students should request that your school provide your GPA converted to a 4.0 scale.
High school students who have taken dual-enrollment courses at a community college do not need to send transcripts from that college.
Current undergraduate students who have taken courses at multiple colleges only need to send transcripts from the final college to which they
transferred previous credits and earned/are earning a degree.
Current undergraduate students who have been out of high school for more than five years only need to send college transcripts. High
school transcripts and SAT/ACT scores are not required.
College transcripts must show the most recently completed semester.
Statement of Family Income & Resources (pages A1-A2) and Statement of Need -- If you are applying for any need-based scholarships you
must submit this information.
APPLICATION DEADLINE: FEBRUARY 28, 2014
Founded in 1950, Hampton Roads Community Foundation was Virginia's first community foundation. In 1951 the Foundation received its first scholarship fund.
Today it administers more than 60 scholarships that are helping more than 350 students achieve their academic goals each year. Since 1951 the Foundation has
awarded more than $18 million in scholarships and helped more than 3,900 students.
Personal Statement C, if applying for Jarrod Camper Smith Memorial Scholarship (NO MORE THAN TWO PAGES)
your application in sealed envelopes with the recommenders' signatures across the seals. Recommendations should be from school
faculty or staff, coaches, employers or ministers who know you well and can comment on your academic potential, initiative, qualities that
set you apart and any special circumstances you have overcome. Recommendations from friends and relatives will not be accepted.
If you are interested in a scholarship that requires participation in a specific activity or dedication to a specific career field, consider
having one of your recommenders be the faculty sponsor for that activity or someone who is familiar with the work you have done
that relates to that career field. If you are applying for the Jennifer Mooney Greene Scholarship, one of your recommendations must be
written by your AVID coordinator.
Personal Statement D, if applying for Adrian Ryan Kirk Memorial Scholarship (NO MORE THAN TWO PAGES) & disability documentation
Personal Statement E, if applying for George D. and Marion Phelps Hamar HRBOR Scholarship (NO MORE THAN TWO PAGES)
Student Aid Report -- If you are applying for any need-based scholarships you must submit this information. You can file the FAFSA as early as
January 1 using estimated tax information. Once you file taxes, you can make corrections to the FAFSA. Many colleges have a February 15 priority
filing deadline. Students who file the FAFSA after the college's priority deadline may miss out on being considered for need-based grants,
scholarships, the Federal Perkins Loan and Federal Work-Study. It is in your best interest to file the FAFSA early. If you file online, you should
receive an e-mailed SAR in a few days. Submit a copy of the SAR with this scholarship application. Include ALL pages of the SAR.
Visit http://www.hamptonroadscf.org/scholarships/documents/SARAcceptableFrms.pdf to see examples of what a SAR looks like.
Note on parental information:
If your parents are divorced or separated, provide information about the one with whom you lived most during the past year.
If you did not live with one parent more than the other, provide information about the parent who provided the most financial support.
If this parent is remarried, provide information about that parent and your stepparent.
SAT scores --Enclose a copy of your College Board score report(s) showing your highest scores or check with your school to find out if they will
include your test scores on the transcript. Do not include copies of the essay section. Submit only the summary of your scores. If you have not
taken the SAT, please submit your ACT score report(s).
Statement of family income and resources

Students who wish to be considered for need-based scholarships MUST complete this form.
Note: ALL scholarships are need-based except the Gilbert, Fang, Kirk, Morrison and Jarrod Camper Smith scholarships.
Page A-1
Will you be attending college with a:
NCAA scholarship /yr Yes No Sport & Division Amount $
ROTC scholarship /yr
Yes No Military Branch Amount $
Amount $
performance scholarship /yr
(e.g., band, dance team, cheerleading, debate, theater, non-NCAA sport, etc.)
Yes No Activity
Other sources of assistance: /yr /yr
/yr /yr
Have you received your financial aid award letter from the school you plan to attend?
If yes, please submit a copy of your award letter with your application. If you are undecided, send award letters from your top two choices.
tuition waiver $ Veteran's educational benefits $
tuition reimbursement from employer $ $ Other
Yes No
Amount of savings available for your college education $
Please list the source(s) of those funds here. (e.g., Education IRA, prepaid tuition, trust fund, personal savings accounts)
List all scholarships that you have been awarded for next year. Include the amount in parentheses next to the name of the scholarship.
Name
Do you live in pubic housing? If yes, provide name of
community/neighborhood
Are you in the Housing Choice If you are not currently in public housing Are you currently homeless?
Voucher(Section 8) Program? or Section 8, are you on the waiting list?
List all dependent children other than the applicant:
Name Age
Relationship to
Applicant
School, college or occupation Grade Level
Total number of
persons in household:
STATEMENT OF FINANCIAL NEED
Attach a typed statement describing any unusual factors concerning your need for financial assistance (e.g., financial hardship, disabilities,
family situations including size, unusual responsibilities and challenging circumstances). One page maximum.
Yes No
Yes No No Yes
Yes No
Are you a ward of the court? Current placement
(If you recently turned 18 but were a if not residing with
ward of the court until then, check yes.) parents:

Are you an emancipated minor?
No Yes Foster home w/ relative
Legal guardian - relative
No Yes
Foster home w/ non-relative
Legal guardian - non-relative
Group living Independent living
Highest level of education your mother completed:

Highest level of education your father completed:
Middle school/Jr. high High school Some college, no degree Associate's degree
Bachelor's degree Master's/professional degree or above Unknown
Middle school/Jr. high High school Some college, no degree Associate's degree
Bachelor's degree Master's/professional degree or above Unknown
Page A-2
Name
Please complete the STUDENT INFORMATION section of this form. If you are a dependent student, you must also have your parents complete the
PARENT INFORMATION section. If federal income taxes have not been filed by the time you are filling this out you must use estimated numbers.
You are a dependent student if you are under 24 years of age unless you: (1) are a ward of the court; (2) are married and living away from your parents;
(3) have not been claimed by your parents for two consecutive years and have earned at least $4,000 in each of those years; or (4) have served in the military.
I am Dependent (complete BOTH columns) I am Independent (complete student column only)
PARENT INFORMATION STUDENT INFORMATION
Source of income information
2013 Estimated numbers to be filed
2013 Actual numbers/Already filed 2013 Actual numbers/Already filed
2013 Estimated numbers to be filed
Annual income earned from work (wages,
salaries, tips)
Father/Stepfather $
Occupation
Mother/Stepmother $
Occupation
Employer
Employer
Employer
Student $
Occupation
Spouse $
Occupation
Employer
Net income from business, farm, rents, royalties,
partnerships, estate trusts $ $
Annual income from alimony and child support $ $
Annual government benefits
Social Security/SSI $
TANF $ TANF $
Social Security/SSI $
Other income (e.g., pensions, annuities, interest,
unemployment, military allowances, etc.) $ $
Value of savings account, trust funds and other
investments (excluding retirement accounts) $ $
Net value of real estate not used as primary
residence
$ $
Student loan debt

Enter loans for children only.
DO NOT include loans from
parents' education. $ $
You must attach a copy of your complete Student Aid Report (SAR) showing the responses you provided on the FAFSA and your
Expected Family Contribution (EFC).

The information provided on this form is true and complete to the best of my (our) knowledge. I (We) realize that failure to comply with a request
by Foundation for further information may prevent the applicant from receiving any aid.
APPLICANT'S SIGNATURE
PARENT'S SIGNATURE
DATE
DATE
DIVORCED, SEPARATED OR REMARRIED PARENTS: Please answer the following questions if you are a dependent student and your natural
or adoptive parents are not married to one another.
A.

B.



C.
D. Is there an agreement or court order specifying a financial contribution for the student's college education?
Year of legal separation or divorce
Other parent's name
Address
Occupation/Employer
According to court order, when will support for the student end? (MM/YYYY)
No Yes
If yes, specify terms of agreement.
Applicant's current marital status: Divorced Separated Married Single Widowed
Widowed Divorced Single Separated Married Parents' current marital status: