Examples

Document Sample
Examples Powered By Docstoc
					                          Billy Gene Edmiston
                         Scholarship Foundation
                Eldorado High School Scholarship Application - 2012
                                            Student Information
Applicant’s Name:
Address:
City, St, Zip:
Home Phone:                                             Cell Phone:
E-mail Address:
Soc. Sec. No.:
U.S. Citizen:             Yes      No                   Texas Resident:              Yes      No
                                                        (For Tuition Purposes)

Marital Status:        Single
# of Children:
Applicant’s Annual        $0 - $2,500                         $5,000 - $10,000
Income:
                          $2,500 - $5,000                     >$10,000

                                        Parent’s Information
Father’s Name:                                          Employer:
Mother’s Name:                                          Employer:
Address:
City, St, Zip:
Home Phone:                                             Cell Phone:
E-mail Address:
Parent’s Annual Income:             $0 - $25,000                          $50,000 - $75,000
                                    $25,000 - $50,000                     >$75,000
Father’s Education Level:           No High School Degree                 Bachelors Degree
                                    GED                                   Masters Degree
                                    High School Graduate                  Doctorate Degree
Mother’s Education Level:           No High School Degree                 Bachelors Degree
                                    GED                                   Masters Degree
                                    High School Graduate                  Doctorate Degree
Total # of Children:
 In Secondary School:
 In College:
 Graduated from College:


                                                PAGE 1 OF 5
                           Billy Gene Edmiston
                          Scholarship Foundation
               Eldorado High School Scholarship Application - 2012

                                      High School Accomplishments
Academic
Achievements:
Athletics
Participation and
Awards:
Extracurricular:
(Student council, UIL
competitions, FFA/4H,
etc.)

College Credits:        In the table below, list all college credits obtained via classroom instruction, Internet, or
                        college entrance exams. Add rows to the table if necessary.
College/University/Exam                        Class/Course                       Date Completed        Grade/Score




SAT Score:                                                                        ACT Score:
High School GPA:                      As of Date:
Class Rank #:                         out of        .
Date of Graduation:
                                           Educational Institutions
Date Entering College:                                                      Est. Work Hours Per
                                                                            Semester:
Declared Major &                                                            Est. College Hours
Minor:                                                                      Per Semester:
Colleges Being                 In the table below, list the top three colleges you are considering to attend. Rank
Considered:                    them from #1 to #3. Also, indicate if you have been accepted to the university.
  #                           College/University                            Accepted (Y/N)        Est. Annual Costs:
  1
  2
  3




                                                    PAGE 2 OF 5
                           Billy Gene Edmiston
                          Scholarship Foundation
             Eldorado High School Scholarship Application - 2012
Financial Aid Received:      In the table below, describe any financial aid you have already received or will
                             receive by each category. Indicate if the funds are a one-time amount or recurring
                             over the course of several periods. Examples:
                              Billy Gene Edmiston Scholarship Foundation: $1,000 for one year
                              Carr Scholarship: $2,500 per year for 4 years; tuition only
                              529 College Plan: $35,000
 Scholarships:
 Grants:
 Loans:
 College Saving Plans:
                                      Personal Statement/Biography
Using the space below, please provide a narrative statement describing any community or civic service
performed, demonstration of leadership activities, volunteer activities, full-time, part-time and summer work. In
addition, provide information regarding your educational goals and objectives while attending college along with
how you plan to use your education in the future. And finally, provide an explanation of why you would be a
good recipient to receive the Billy Gene Edmiston Eldorado High School Scholarship. NOTE: It is suggested to
refer to other sections of this application where appropriate as opposed to repeating the information. Also, since
the application is submitted electronically, don’t worry about the length of the text for this section.




                                                   References
                                                                                                    Reference Letter
  #                         Reference Name                                  Phone #                 Attached (Y/N)
  1
  2
  3
  4
  5
                                                 Attachments
In the table below, list any electronic attachments you are submitting with the application form.
 #                                                  Attachment Name
 1
 2
 3




                                                   PAGE 3 OF 5
                            Billy Gene Edmiston
                           Scholarship Foundation
                Eldorado High School Scholarship Application - 2012

                                        Release & Privacy Provisions
   “I hereby grant permission to use the information provided for recognition purposes, if selected. I also give
permission to release information concerning my academic progress to donors of the scholarship I may receive.”
    “I hereby certify that the information provided on this application is accurate and correct. I understand and
agree that if any information is subsequently found to be inaccurate or falsified, I shall return all funds given to
me by the Billy Gene Edmiston Scholarship Foundation within 30 days notice of violation.”
    All information provided on this application form will be held confidential and viewed only by the
     scholarship selection committee of the Billy Gene Edmiston Scholarship Foundation.
    Under the guidelines and laws of the Internal Revenue Service and The State of Texas for 501(c)3 and non-
     profit corporations, members of these governmental agencies may request to view submitted scholarship
     application forms to ensure the Billy Gene Edmiston Scholarship Foundation is compliant with state and
     federal laws.

                                                Official Use Only
Date Received:
(Not for Applicant)

                                           Submission Instructions
Questions:
    Please submit all questions via e-mail to the following individuals:
     1.   Gene Edmiston: gene_edmiston@hotmail.com
     2.   Maureen Hodges: m3hodges@aol.com
     3.   Paige Ragsdale: paige.ragsdale@scisd.net
    Either Mr. Edmiston, Ms. Hodges, or Ms. Ragsdale will reply back to the submitter, including the other
     selection committee members
Completed Application:
    Change the filename of the application file you submit as follows:
     1.   “Eldorado High School Scholarship Application – 2012 – <your name>.doc”
    Please submit the completed application in electronic form via e-mail to the following individuals:
     1.   Gene Edmiston: gene_edmiston@hotmail.com
     2.   Maureen Hodges: m3hodges@aol.com
     3.   Paige Ragsdale: paige.ragsdale@scisd.net
    Applications should not be submitted before April 23, 2012, and no later than May 15, 2012
General:
    Please don’t leave any areas blank; put “N/A” for Not Applicable



                                                    PAGE 4 OF 5
                           Billy Gene Edmiston
                          Scholarship Foundation
             Eldorado High School Scholarship Application - 2012
                      Scholarship Description and Eligibility Requirements
Scholarship Description:
MISSION: To provide scholarships to needing and deserving high school graduating students.


One (1) $1,000 scholarships will be awarded to high school graduating students on the basis of financial need as
well as academic and extracurricular accomplishments. Half of the scholarship amount will be paid in the fall
semester with the remaining paid in the spring semester of the recipient’s first year of college.


Eligibility Requirements:
   Recipient must graduate from high school
   Recipient must attend an accredited educational institution
   Recipient must enroll and complete a full schedule of a minimum of 12 semester hours
   Payment will be made directly to the educational institution
   Recipient must have a 2.5 GPA or higher in the fall semester to receive the scholarship payment for the
    spring semester
   If the recipient for the fall semester fails to maintain the minimum grade requirements, the/an alternate
    recipient will be eligible to receive the second semester payment (assuming alternate recipient maintains the
    minimum grade requirements)
   Electronic Application Location: “K:\Scholarship Applications”

   IMPORTANT NOTE: To receive the funds for this application, the recipient MUST
    contact Gene Edmiston at “gene_edmiston@hotmail.com” or by phone at 713-502-
    3367.




                                                  PAGE 5 OF 5

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:49
posted:6/24/2012
language:
pages:5