Spouses’ Club of Fort Eustis by bzs14448

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									                        INFORMATION SHEET

                  Spouses’ Club of Fort Eustis
           High School Senior Eligibility Requirements

    High School Seniors applying for a SCFE scholarship must have
a GPA (as of the 7th semester of high school) of 3.00 or better.

ALSO

  To be eligible to receive a scholarship from the Spouses’ Club of
Fort Eustis, the applicant must be a dependent child or dependent
spouse of ONE of the following:

1. Active duty/reserve military personnel stationed at Fort Eustis or
   Fort Story.
2. Active duty/reserve Army personnel whose family/dependents
   reside in the Fort Eustis/Fort Story community.*
3. POW/MIA or deceased Army personnel whose family resides in
   the Fort Eustis/Fort Story community.*
4. Retired Army personnel residing in the Fort Eustis/Fort Story
   Community.*
5. Valid DOD ID card holder working at Fort Eustis/Fort Story.
6. Current member of Spouses’ Club of Fort Eustis.
   (Membership is not required in order to apply.)

  * The Fort Eustis/Fort Story community includes the Peninsula,
  Gloucester, and Southside.

  Previous winners of an SCFE scholarship are not eligible.

  Eligibility disputes will by decided by the Scholarship Chairperson,
whose decision is final.
                            LETTER OF CERTIFICATION

I certify that the information I have provided in the attached application is accurate to the
best of my knowledge, and the essay is entirely my own effort. I further certify that
should I accept the SCFE Scholarship, I am not currently, nor will I be in violation of the
following restrictions:

1) All funds received shall be applied toward enrollment (tuition, housing, etc.) expenses
or other necessary expenses such as books, supplies, or computers. Award checks will be
sent to the school of your choice upon receipt of enrollment verification to be credited to
your account. If the award exceeds enrollment expenses or other necessary expenses, the
remainder must be returned to SCFE Scholarship Chairperson as soon as possible.

2) SCFE Scholarship Program funds must be used in the 2009-2010 academic year with
verification of enrollment postmarked no later than March 10, 2010.

Should I violate any of these restrictions, my parents and I agree to return all award
money to the Spouses’ Club of Fort Eustis. Scholarships that have been returned to the
SCFE will be redistributed at the discretion of the SCFE.

In accordance with the Privacy Act of 1974, I agree that my signature on this form will
authorize the Scholarship Chairperson to release copies of my transcripts, scholarship
application, and other data to the Scholarship Committee as needed. Should I be selected
to receive a SCFE Scholarship my signature authorizes the use of select information to be
published in the local newspapers.

STUDENT NAME           ____________________________________________

PHONE # ___________________________

EMAIL ADDRESS _______________________________________________________

ADDRESS ______________________________________________________________

            ______________________________________________________________

STUDENT SIGNATURE _______________________________________

PARENT SIGNATURE ________________________________________




                         #________ (FOR SCHOLARSHIP CHAIRPERSON ONLY)
                                SPOUSES’ CLUB OF FORT EUSTIS
                                      HIGH SCHOOL SENIOR APPLICATION
                                          2009-2010 ACADEMIC YEAR
      Your application packet will be assigned a number and the selection committee will judge applications with all
       identifying information removed.
      Ensure the information you provide is complete (NO ABBREVIATIONS; INDICATE IF YOU HELD AN
       OFFICE (AND YEAR THAT OFFICE WAS HELD) IN AN ORGANIZATION; BEGIN A NEW LINE FOR EACH
       ENTRY; INDICATE YEARS OF PARTICIPATION, AND IF PARTICIPATION WAS NOT AT A LOCAL HIGH
       SCHOOL PLEASE INDICATE ON APPLICATION WHERE PARTICIPATION OCCURRED).
      In order to preserve anonymity, the selection committee will not be able to contact you for further information.
      Be sure to make a copy of this application for your records.
      ATTACH A COPY OF BOTH THE FRONT AND BACK OF MILITARY OR DOD ID CARD. Please include a self
       addressed stamped envelope.
      Send this completed application packet to: Lynn Hutcheson, 2926 Summerall Circle, Ft. Eustis, VA
       23604, (757) 503-3147. It must be postmarked NO LATER THAN MARCH 13, 2009. NO LATE ENTRIES
       OR ADDITIONS WILL BE ACCEPTED.

Name _____________________________________________________ Date of Birth _________________
               Last                     First                   Middle

Address _________________________________________________________________________________________
                           Street                               City                      Zip

Home Phone ________________________                  Email Address _______________________________________

Sponsor’s Name __________________________________________                     Work Phone_______________________
                      (Last)                    (First)                    (Rank)

Branch of Service _______________

Parent or Spouse Eligibility: (Check One)
       Military:____Active Duty/Reserve at Fort Eustis/Story               ____Retired Army in Fort Eustis/Story Community

                ____Deceased Army Fort Eustis/Story Community              ____POW/MIA in Fort Eustis/Story Community

       Civilian: ____FEOCSC Member                                         ____DOD ID Card Holder at Fort Eustis/Story

TO BE COMPLETED BY GUIDANCE COUNSELOR. Please complete and attach a copy of complete high school
transcript and return to Lynn Hutcheson (address above). All items must be postmarked NLT March 13, 2009.
Thank you.

Name of High School: _______________________________ Phone No. _____________________

School Address: __________________________________________________________________

GPA (based on 7 semesters of high school):                weighted ___________ unweighted _____________


Test Scores: SAT __________           (total Math and Verbal)            ACT: _______________

Counselor’s Signature: __________________________________ Date ____________________


                               #________ FOR SCHOLARSHIP CHAIRPERSON ONLY
SCFE SCHOLARSHIP APPLICATION                                     PAGE 2
HIGH SCHOOL SENIOR

**1. Please attach to this application a short essay (200-250 words) on
what course of study you plan to pursue and why.


2.LIST ALL COLLEGES AND SCHOOLS TO WHICH YOU HAVE APPLIED OR
HAVE BEEN ACCEPTED.
College/School            Location            Applied/Accepted
_____________________     ___________________ _____________
_____________________     ___________________ _____________
_____________________     ___________________ _____________
_____________________     ___________________ _____________




3. LIST ALL HIGH SCHOOLS (OTHER THAN CURRENT HIGH SCHOOL)
ATTENDED (GRADES 9 THROUGH 12 ONLY):

      High School              Location - City/State      Dates Attended

_______________________   ____________________________     _______________
         _____                        _____                      ____
_______________________   ____________________________     _______________
         _____                        _____                      ____
_______________________   ____________________________     _______________
         _____                        _____                      ____
_______________________   ____________________________     _______________
         _____                        _____                      ____




                #_______ FOR SCHOLARSHIP CHAIRPERSON ONLY




**Must be completed in order for application to be accepted.
SCFE SCHOLARSHIP APPLICATION                                        PAGE 3
HIGH SCHOOL SENIOR

4. LIST ALL SPORTS RELATED ACTIVITIES WHILE IN GRADES 9 THROUGH 12 (i.e.,
school, community, Youth Services sports and all cheerleading activities).
Activity                         Name of Coach/Supervisor
Position                         and phone #, if available     Fr So Jr Sr

______________________________   ___________________________   __ __ __ __
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                   #______FOR SCHOLARSHIP CHAIRPERSON ONLY
SCFE SCHOLARSHIP APPLICATION                                           PAGE 4
HIGH SCHOOL SENIOR

5. LIST ALL COMMUNITY VOLUNTEER ACTIVITIES WHILE IN GRADES 9
THROUGH 12: (i.e., Chapel, Red Cross, ACS, etc.) Give the name of the
activity sponsor or teacher who can verify your participation.
Activity                   Name of Sponsor             Hrs./week        (Year)
Position                   and phone #, if available   or one time   Fr So Jr Sr
                                                          event

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________________________   ________________________

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                   #______ FOR SCHOLARSHIP CHAIRPERSON ONLY
SCFE SCHOLARSHIP APPLICATION                                      PAGE 5
HIGH SCHOOL SENIOR

6. LIST ALL ACTIVITIES (OTHER THAN SPORTS ACTIVITIES) WHILE IN GRADES 9
THROUGH 12: (i.e., scouts, student council, yearbook, school paper,
JROTC, academic clubs, drill team, band, orchestra, singing groups, private
music lessons, drama and speech activities, etc.) Indicate if you have held
an office or performed a special duty. Give the name of the sponsor or
teacher who can verify your participation.
Activity                     Name of Sponsor                   (Year)
Position                     phone #, if available           Fr So Jr Sr

________________________    _____________________________    __ __ __ __
________________________    _____________________________
                                 attends: (Circle one)
                             regularly occasionally rarely

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                                 attends: (Circle one)
                             regularly occasionally rarely

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                                 attends: (Circle one)
                             regularly occasionally rarely

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                                 attends: (Circle one)
                             regularly occasionally rarely

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                                 attends: (Circle one)
                             regularly occasionally rarely

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                                 attends: (Circle one)
                             regularly occasionally rarely



                   #______FOR SCHOLARSHIP CHAIRPERSON ONLY
SCFE SCHOLARSHIP APPLICATION                                         PAGE 6
HIGH SCHOOL SENIOR

6. LIST ALL EXTRACURRICULAR ACTIVITIES (CONTINUED).

Activity                     Name of Sponsor                   (Year)
Position                     phone #, if available           Fr So Jr Sr

________________________    _____________________________    __ __ __ __
________________________    _____________________________
                                 attends: (Circle one)
                             regularly occasionally rarely

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________________________    _____________________________
                                 attends: (Circle one)
                             regularly occasionally rarely

________________________    _____________________________    __ __ __ __
________________________    _____________________________
                                 attends: (Circle one)
                             regularly occasionally rarely

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                                 attends: (Circle one)
                             regularly occasionally rarely

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                                 attends: (Circle one)
                             regularly occasionally rarely

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                                 attends: (Circle one)
                             regularly occasionally rarely

________________________    _____________________________    __ __ __ __
________________________    _____________________________
                                 attends: (Circle one)
                             regularly occasionally rarely

                   #______FOR SCHOLARSHIP CHAIRPERSON ONLY
SCFE SCHOLARSHIP APPLICATION                                          PAGE 7
HIGH SCHOOL SENIOR
7. LIST ALL SCHOOL, ACADEMIC, SPORTS AND COMMUNITY HONORS,
AWARDS AND ACHIEVEMENTS. (i.e. All-Conference and/or All-European
team and individual sports, Model United Nations, National Honor Society,
National Merit Scholarship semi-finalist, etc.) As a reference provide the
name of an adult leader or someone who can verify your achievement.

Honor/Award/Achievement                 Reference             Fr So Jr Sr

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________________________________   ________________________   __ __   __ __

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                   #______FOR SCHOLARSHIP CHAIRPERSON ONLY
SCFE SCHOLARSHIP APPLICATION                                             PAGE 8
HIGH SCHOOL SENIOR

8. LIST ALL EMPLOYMENT WHILE IN GRADES 9 THROUGH 12. INCLUDE
SUMMER JOBS. (Under “when”, indicate whether the job is performed
during the summer, before or after school hours and/or weekends.
Include month and year of start date and month and year of end date or
no credit will be given. If you are currently employed please circle that
entry.

Employer                   Supervisor signature          Average        When
Position                   and phone #                   Hrs./Week     Month/yr to
Supervisor’s name          (Required for current)                      Month/yr

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                    #______FOR SCHOLARSHIP CHAIRPERSON ONLY

								
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