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Please print this form, and mail completed form to: Scholarship Committee, American Board of Funeral Service Education, 3432 Ashland Avenue,
Suite U,
St. Joseph, MO 64506
ABFSE students are eligible for one scholarship award each calendar year.
Return links to the ABFSE Website are at the bottom of this page.
A. Personal Information
Name:________________________________________________________
Permanent Address: Street or Box: ________________________________
City: __________________________ State: _____ Zip: _______________
Current Address (if different): Street or Box: ________________________
City: __________________________ State: _____ Zip: _______________
Date of Birth: ___________ Place: ________________________________
Citizenship Status: US______ Other (specify) _______________________
Marital Status: Married____ Single____ Separated____ Divorced____
Dependents: (Number and ages) __________________________________
______________________________________________________________
B. Parent’s Information (complete only if you are declared a dependent on your parent’s federal income tax form for the last year)
Father’s Name: _________________________________________________
Address: Street or Box: __________________________________________
City: __________________________ State: _____ Zip: _______________
Father’s Occupation: ____________________________________________
Name of Firm: __________________________________________________
Mother’s Name: _________________________________________________
Address: Street or Box: __________________________________________
City: __________________________ State: _____ Zip: _______________
Mother’s Occupation: ____________________________________________
Other Dependents in Family:
Name: Age: College last year? Fees paid by parents:
______________________________________________________________
______________________________________________________________
Note: Applications must be accompanied by one of the following:
If you are declared as a deduction on your parents’
income taxes, you must provide the committee with a photocopy of page 1 of your parents’ 1040 Form for last year.
If you are not
declared as a deduction on your parents’ income taxes, you must provide the committee with a photocopy of page 1 of your own 1040 Form for last year.
C. Personal Financial Statement: Explain how you are planning to pay for your Mortuary School education. Be sure to include
estimated expenses (i.e. tuition, room and board, etc.) and support (i.e. occupation income, parental support, personal savings, grants and loans, etc.) for the next school year.
Please add a blank page at the end of this application for your response. Be sure to type your response.
D. Spouse’s Information (if applicable)
Name: ________________________________________________________
Address (if other than yours): Street or Box: _____________________
City: __________________________ State: _____ Zip: _______________
Occupation: ___________________________________________________
Name of Firm: __________________________________________________
If spouse files a separate tax return, you must provide a photocopy of page 1 of the last year’s return.
E. Educational/Military Background:
High School Years attended Year Graduated
______________________________________________________________
Colleges Years attended Major Year Graduated
______________________________________________________________
______________________________________________________________
______________________________________________________________
Other educational experiences you consider important for us to know about
if any (i.e. military, international, etc.):
______________________________________________________________
Military Background (if any)
Branch Period of service Rank obtained
______________________________________________________________
F. School and Community Activities:
School activities Dates of participation Hrs. per week
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Civic/Church activities Dates of participation Hrs. per week
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
G. Funeral Service Education information:
ABFSE school you are attending: _________________________________
_____________________________________________________________
Date your studies there began:___________________________________
Expected date of graduation:__________ Diploma or Degree?___________
H. Work Experience: list jobs including summer employment
Job Held Employer Dates of Employment Hrs. per week
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
I. Tell us about yourself (required):
Tell us why you chose funeral service as a profession. Please include significant
experiences and special people that have had an impact on this decision. Please share with the Committee a brief personal history.
Please add a blank page at the end of this response for your essay if necessary.
Be sure to type your essay.
J. Letter of Recommendation (required):
Submit a typed letter of recommendation from someone other than faculty member or mortuary college official,
family member, or friend on appropriate letterhead stationary.
K. College Transcripts (required):
Submit a copy of transcripts from every
college you have attended (even though may not have graduated). At least one of the transcripts must indicate that you have completed at least one complete term of study in funeral service or mortuary science.
L. Federal Tax Form 1040 (required):
Submit a copy of either: parents’ 1040 if you are declared as a dependent for tax purposes, or your own 1040 if you are not declared as a parental deduction.
M. I certify that the above information is true and can be verified by proper
documentation, if required:
Your signature: _______________________________________________
Date: _______________________________________________________
Mail (faxes will not be accepted) completed form to:
Scholarship Committee
American Board of Funeral Service Education
3432 Ashland Avenue, Suite U
St. Joseph, MO 64506
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