ALPHA XI DELTA SCHOLARSHIP APPLICATION DEADLINE: All materials must be postmarked no later than March 15, 2012 Alpha Xi Delta Foundation, Attn: Claressa Basile 8702 Founders Road • Indianapolis, IN 46268 • p. 317.872.3500 • f. 317.872.2947 • email@example.com Foundation scholarships are available to initiated members in good standing. Only completed applications will be considered. A completed application includes the following: A four-page application form Personal Statement An official college/university transcript(s) from the registrar’s office Photocopies and faxed copies will not be accepted. Scholarship recommendation form This recommendation form should be completed by an Alpha Xi Delta alumna in good standing, preferably a volunteer or advisor. Letter of recommendation This recommendation should be from a current or former employer or college/university faculty member. Suggestions Watch the clock. Follow up with the registrar’s office and those completing recommendations to ensure that all supporting materials arrive by the deadline. Activities. Do not list high school activities. Please list Alpha Xi Delta involvement separately from community activities, including philanthropy and service activities. Don’t Assume. For activities and awards that are unique to your university, major or otherwise, please provide a brief explanation. For example, it would be helpful for the person reviewing your application to know that “Kappa Delta Pi is an honor society for education majors.” Recommendations. Seek out those individuals who know you well. They will be in a better position to address your strengths and contributions. Submitting documentation. Try to send all items together to ensure they are postmarked by the March 15 deadline. If items are not sent together, you may contact Claressa Basile at firstname.lastname@example.org to ensure all items have been received. Alumna Scholarship Application This form is to be used if the applicant is an alumna member on March 15, 2012. Alpha Xi Delta Foundation scholarships are available to alumnae members returning to school who were in good financial standing with their chapter as collegiate members. Amounts range from $500- $2,000. Criteria will include Alpha Xi Delta and community involvement, academic achievement, professional experience, the applicant’s goals, references, and financial need. The applicant will be notified about the status of her application after June 1, 2012. A completed application includes: completed four-page application form Must Be Postmarked By: official transcript(s) sent to the Alpha Xi Delta MARCH 15, 2012 Foundation from the registrar’s office of each college/university attended MAIL, FAX or EMAIL to: a) Undergraduate Alpha Xi Delta Foundation b) Current thru first semester or quarter ATTN: Claressa Basile of the current academic year 8702 Founders Road personal statement Indianapolis, IN 46268 recommendation form completed by an Alpha Fax: 317.872.2947 Xi Delta alumna (preferably a volunteer or Email: email@example.com advisor) letter of recommendation from a current or Questions? Contact Alpha Xi Delta Foundation at 317.872.3500 or firstname.lastname@example.org. former employer or academician How did you learn about this scholarship opportunity? Name (Last) (First) (Middle/Maiden) Mailing Address (Address) (City) (State) (Zip Code) Phone Email Chapter University Date Initiated Number of Years as a Collegiate Chapter Member Undergraduate Degree/Major Undergrad Cumulative GPA/Scale / Undergrad Graduation Date Marital Status Number of Children Have you applied to graduate school? Have you been accepted? Applicant Name: Graduate Education College/University Degree Program/Major Anticipated Graduation Date Cumulative GPA/Scale / Credit Hours Completed Estimated Credit Hours in 2012/2013 Campus Studies Online Studies FINANCIAL STATEMENT Applications are held in confidence by the committee. Please review the financial statement example on the last page of application before completing. Financial Statement Your estimated income and expenses for the 2012-2013 academic year INCOME EXPENSES Amount Amount Employment Tuition & Fees From your family (amount your family Room & Board will contribute to your education) Loans Books & Supplies Scholarships, grants, awards Undergraduate loan repayment Spouse income Other expenses Other income TOTAL INCOME $ TOTAL EXPENSES $ Income from this scholarship may be taxable. Check with your tax consultant. PERSONAL STATEMENT On a separate sheet (use as many sheets as necessary), please respond to questions 1-5: 1. Work Experience – List all professional experience including internships. 2. What are your educational goals and career objectives? 3. What would you be able to accomplish if you received an Alpha Xi Delta Foundation scholarship that you would not otherwise be able to accomplish? 4. What does ’s “lifetime commitment” mean to you? 5. Describe special circumstances or financial need and the efforts you have made to help yourself financially. Applicant Name: COLLEGIATE & ALUMNAE INVOLVEMENT List all collegiate and alumna offices (elected, appointed), committee activities/offices, volunteer activities, non- academic awards and recognition related to Alpha Xi Delta. Status: C = Collegiate; A = Alumna Type of Office: E = Elected, A = Appointed; Status Type of Office C A E A n/a Year Alpha Xi Delta Office: Service Office: Office: Office: Office: Office: Panhellenic Office: Panhellenic Office: Panhellenic Office: Panhellenic Office: Committee Chair: Committee Chair: Committee Chair: Committee Chair: Committee Chair: Committee Member: Committee Member: Committee Member: Committee Member: Committee Member: Activity: Activity: Activity: Activity: Activity: Activity: Award/Honor: Award/Honor: Award/Honor: Other: Other: Other: List all volunteer activities not related to Alpha Xi Delta. Year Community Activity/Membership: Activities Activity/Membership: Activity/Membership: Activity/Membership: Activity/Membership: Activity/Membership: Activity/Membership: Activity/Membership: Activity/Membership: Applicant Name: COLLEGIATE & ALUMNAE INVOLVEMENT (CONT.) List all professional, academic, and community awards, honors and special recognitions. Please indicate if you have previously received a scholarship from Alpha Xi Delta Foundation. p (Y/N) Year Awards, Honors, No and Special No Recognition No No No No No No No No No No No No No No No No List all campus activities and include leadership responsibilities. Type of Office Elected Appointed n/a Year Campus Office: Activities Office: Office: Office: Office: Committee Chair: Committee Chair: Committee Chair: Committee Chair: Committee Member: Committee Member: Committee Member: Committee Member: Committee Member: Activity: Activity: Activity: Activity: Activity: Award/Honor: Award/Honor: Award/Honor: Award/Honor: Other: Other: SCHOLARSHIP RECOMMENDATION FORM This section to be completed by applicant: to be completed by an Name_________________________________________ Alpha Xi Delta alumna Address_______________________________________ Must Be Postmarked By: March 15, 2012 ______________________________________________ Phone_________________________________________ Email_________________________________________ Instructions: Please complete this form and return to the applicant in a sealed envelope with your signature across the seal. This recommendation will remain strictly confidential. Your thoroughness and care in providing this information requested are sincerely appreciated. Capacity in which you have known the applicant: ____________________________________ Length of time you have known the applicant: _______________________________________ Based on your relationship with the applicant, please rate the following by circling the appropriate response: Very Weak Average Strong Exceptional Strong Leadership quality/potential 1 2 3 4 5 Alpha Xi Delta, campus, and/or 1 2 3 4 5 community involvement Relationship with peers and others 1 2 3 4 5 Acceptance of responsibility 1 2 3 4 5 Financial need 1 2 3 4 5 Personal comments (required): Please include information you believe to be relevant in the selection of this applicant, including knowledge of special needs. Attach additional sheets if necessary. Signature of alumna recommender Date Name (please print) Mailing Address Phone Email Alpha Xi Delta role or volunteer position Initiating chapter/initiation year / This section to be completed by applicant: SCHOLARSHIP Name_________________________________________ LETTER OF RECOMMENDATION FORM Address_______________________________________ to be completed by a current or former employer or academician ______________________________________________ Phone_________________________________________ Must Be Postmarked By: March 15, 2012 Email_________________________________________ Instructions: The applicant will be considered for a scholarship from the Alpha Xi Delta Foundation. Scholarships are awarded based on achievement, as well as need. To assist in the selection process, it is requested that each applicant submit a letter of recommendation from a current or former employer or academician that includes the following: length of time and capacity in which you have known the applicant; based on your relationship with the applicant, a description of how she makes a difference in her profession, community, and/or in the classroom; description of applicant’s relationship with peers and others; description of how the applicant accepts responsibility; any additional information you believe would be relevant in the selection of this applicant, including any knowledge of financial need; and your name and position (academicians please also include college/university). Letters of recommendation should be accompanied by this sheet. This recommendation will remain strictly confidential. Your thoroughness and care in providing the information requested are sincerely appreciated. Materials may be given to the applicant in a sealed envelope with your signature across the seal or you may send the letter by MAIL, FAX or EMAIL to: Alpha Xi Delta Foundation Attn: Claressa Basile 8702 Founders Road Indianapolis, IN 46268 Fax: 317.872.2947 Email: email@example.com DEADLINE: Letters of recommendation must be postmarked by March 15, 2012. Questions? Contact Alpha Xi Delta Foundation at 317.872.3500 or firstname.lastname@example.org. Financial Information Your estimated income and expenses for the 2012-2013 academic year Income Expenses Amount Amount Employment $24,000.00 Tuition & Fees $ 9,000.00 From your family (amount your family will contribute to your education) Room & Board n/a live at home Loans $ 5,000.00 Books & Supplies $ 800.00 Undergraduate Scholarships, grants, awards $ 1,000.00 loan repayment $ 2,400.00 Other income Other expenses $20,000.00 TOTAL INCOMES $30,000.00 TOTAL EXPENSES $32,200.00 Please keep in mind that these are annual (12-month) figures. For example, for “Tuition & Fees” enter your costs for one academic year, not the total amount of a multi-year program. And for loan repayment, enter the amount that you intend to pay on your loan this year, not the total amount outstanding.
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