ZILLAH SENIOR CITIZENS SCHOLARSHIP

							                                        S.C.A.C. Principal’s Association
                                       Scholarship for Graduating Seniors
                                                      2012

Name: ___________________________________________________                     Date of Birth: __________________

Mailing Address: _____________________________________________________________________

City: ________________________________________, Washington Zip Code:__________________

Parent/Legal Guardians Name(s): ____________________________________________________________

High School:      _________                     Principal: ____________________


College(s), University(-ies) or Technical School(s) you plan to attend next year:______________________

______________________________________________________

Cumulative High School G.P.A.: __________                Class Rank : ______ out of _______

Scores from SAT, ACT or other standardized College entrance exams (Please be specific):

________________________________________________________________________________________


Location of selected school (City, State): _______________________________________________________

    To be complete, your application must include the following information.

___ A copy of your most recent transcript that shows your cumulative G.P.A.

___A statement from your counselor indicating:
       1. You will graduate in the Spring of 2012
       2. That you have completed an application to the post secondary institute(s) listed above.

___A resume that includes your awards and honors, student leadership experiences, school and community service and
other information that you may choose to include.

___A personal statement that includes your educational goals, and why you should be considered for the S.C.A.C.
Principals’ Scholarship (500 word limit)

___Two Letters of recommendation, one of which must come from your building principal or counselor.

___This completed form.

 To be considered for this scholarship, the application must be complete and returned to Mr. Torres

                                         before February 24, 2012
                  S.C.A.C. Principal’s Association Scholarship for Graduating Seniors

                                          Counselor Statement

My signature below verifies that the scholarship candidate ______________________________________

of Zillah High School is on track to graduate with their class in the spring and that the candidate has
applied to the following post-secondary institutions:

                     Applied at:                        Acceptance Received
                                                          Yes         No




Guidance Counselor                                                 Date
                     S.C.A.C. Principal’s Association Scholarship for Graduating Seniors
                     Resume of awards, honors, leadership, service and other information.

                                                        Community Involvement
List community activities during grades 9-12 and “X” the appropriate grade level(s). Please include individual community
service activities in addition to those you participate in as a member of a group. Also indicate the hours per week. Limit your
response to the space provided. One entry per line please.


     COMMUNITY ACTIVITIES            9    10       11    12         LEVEL OF INVOLVEMENT               HOURS PER WEEK




                                         Special Recognition, Awards, and Honors
List special recognition, awards, and honors received during grades 9-12 and “X” the appropriate grade level(s). Include
Commendations not previously listed. Limit your response to the space provided. One entry per line please.

            COMMENDATION                       9    10    11   12                 GROUP OR ACTIVITY
                                                   Student Activities
List the student activities in which you have in during grades 9-12 and “X” the appropriate grade level(s). List leadership
positions held and accomplishments and “X” the appropriate grade level0s). Limit your response to the space provided. One
entry per line please.


          STUDENT ACTIVITIES              9   10   11   12       LEADERSHIP POSITION         9   10   11   12
                                                                 ACCOMPLISHMENT(S)