2010 Horatio Alger Scholarship Application Information The Horatio Alger Association seeks to assist students who have: demonstrated integrity and perseverance in overcoming adversity strength of character financial need a good academic record commitment to pursue a college education a desire to contribute to society Eligibility The eligibility criteria to be considered for National Scholarships and Horatio Alger State Scholarship Programs are as follows: enrollment full time as a high school senior, progressing normally toward graduation in the Spring/Summer 2010, with plans to enter college no later than the fall following graduation; a strong commitment to pursuing and completing a bachelor’s degree at an accredited institution in the United States (students may start their studies at a two-year institution and then transfer to a four-year institution. Idaho, Louisiana, and Montana state scholarship recipients must pursue a degree at specific colleges and universities. Please see the individual program description for those requirements); critical financial need ($50,000 or less adjusted gross income per family is preferred, if higher explanation must be provided); involvement in co-curricular and community activities; a minimum grade point average (GPA) of 2.0; and United States citizenship. Application Instructions To apply for the Horatio Alger Scholarship Programs students must submit the following: The Association strongly prefers that students submit an online application at www.horatioalger.com/scholarships. If students cannot submit the online application, they may complete this paper version, which is a Microsoft® Word fill-in form that allows students to type directly into the form from a computer. Please note that all paper applications must be typed on a computer. All applicants must also submit the certifications page and an official High School transcript with legend. All applicants must have a letter of support submitted on their behalf (instructions are available for the applicant online). Applicants must also submit a copy of the front page of their parent/guardian’s individual tax return (1040, 1040A, 1040EZ or 1099 SSA-Social Security Tax Form) for 2008 in order to verify income stated on application. If your parent(s) AGI is a negative number, please submit copies of parent/guardian's federal individual tax return for the years of 2006, 2007, and 2008. If your parents were not required to file a tax return, include statement copies of any government benefits, such as food stamps or Public Assistance documents. Applicants must mail documents to the Association at the following address by October 30, 2009 (postmark date). No faxed applications will be accepted. The Horatio Alger Scholarship Program PO Box 4030 Iowa City, IA 52243-4030 The Horatio Alger Scholarship Program Scholarship Application This application will provide the Scholarship Selection Committee with an understanding of your experiences and eligibility for consideration in our scholarship programs. The more information you provide, the greater our ability to evaluate your qualifications. All information submitted will remain confidential. Submitting one application will qualify you for consideration for all scholarships for which you are eligible. Online applications and all additional paperwork must be submitted by October 30, 2009. Additional Paperwork Deadline: October 30, 2009 Online letter of support submitted on their behalf (instructions are available for the applicant online). Official High School transcript with legend mailed to Association. Certifications page, which may be downloaded from www.horatioalger.com/scholarships/requiredforms.cfm.. This will require signatures of the applicant, parent/guardian, and the student’s principal or assistant principal. Faxes/emails will not be accepted. Copy of the front page of a parent/guardian’s individual tax return (1040, 1040A, 1040EZ or 1099 SSA-Social Security Tax Form) for 2008 in order to verify income stated on application. If your parent(s) AGI is a negative number, please submit copies of parent/guardian's federal individual tax return for the years of 2006, 2007, and 2008. If your parents were not required to file a tax return, include statement copies of any government benefits, such as food stamps or Public Assistance documents. Additional eligibility criteria (in addition to those noted above) that must be met for state scholarships in the following states: IDAHO– applicants residing in the Idaho counties of Benewah, Boundary, Bonner, Kootenai, Latah, or Shoshone must attend North Idaho College, Lewis-Clark State College (Coeur d'Alene or Lewiston campus) or the University of Idaho. LOUISIANA – applicants must pursue a degree at a college in Louisiana. MONTANA – applicants must pursue a degree at The University of Montana, The University of Montana-Western, The University of Montana-Missoula College of Technology, Helena College of Technology of The University of Montana, or Montana Tech of The University of Montana. Items marked with are required for your application to be considered complete. How did you hear about us? -- Choose one -- If other, please enter here. SECTION 1: Biographical Information Please provide the following information so that the Association may learn more about you. First Name Middle Initial Last Name Date of Birth (mm/dd/yy) Gender -- Select gender -- Address Apartment Number City County State Zip Country Telephone Email Are you a US citizen and currently residing in the United States? Yes No Social Security Number SECTION 2: Financial Information All applicants must submit a copy of the front page of their parent/guardian’s 2008 individual tax return (1040, 1040A, 1040EZ or 1099 SSA). If your parents were not required to file a tax return, include statement copies of any government benefits, such as food stamps or Public Assistance documents. The financial information you provide will be used only by the Horatio Alger Selection Committee to determine financial need. In order to answer the Adjusted Gross Income item below, please refer to your or your parent/guardian’s 2008 federal income tax return. If you are claimed as a dependent on your parent/guardian’s federal tax return, the answer to this item is based on your parent/guardian’s income. Adjusted Gross Income If you are a ward of the state or are in foster care, enter 0 (zero) on the income line above. If AGI is a negative number, please submit copies of parent/guardian’s federal individual tax return for the years of 2006, 2007, and 2008. Total number of people dependent on this annual income, including applicant (located on tax form box 6D) Father/guardian profession Mother/guardian profession Is your parent/guardian currently receiving state or federal financial assistance? Yes No If yes, please list aid programs. If you are not listed as a dependent on your parent/guardian’s federal tax return, please explain why. List all of the individuals who live in your house full-time and their relationship to you. Name of Individual Relationship to You #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 Has one or more of your parents been unemployed in the last 6-12 months? Yes No If yes, what was their occupation before becoming unemployed? SECTION 3: Community Service, Extracurricular Activities, and Employment List your principle activities and interests, both in and out of school, in the order of importance to you. Grades Hours per Weeks per Leadership position Community Service 9 10 11 week year held Example: Habitat for 7 12 Vice President Humanity Grades Hours per Weeks per Leadership position School Activity 9 10 11 week year held Example: Band 7 12 Vice President Indicate how many hours of paid employment you work per week during the summer. Indicate how many hours of paid employment you work per week during the school year. Please indicate your current job/employment position. What motivates you to work? College Readiness Programs Do you participate in a college preparatory program at your high school (AVID, Gear UP, Upward Bound)? List program you have participated in How many years have you participated in this program? Performing Arts Scholarship The Horatio Alger Association is proud to offer a performing arts scholarship to one student who is planning a career in the performing arts. If you wish to be considered for the scholarship, all questions are required. Please consider me for the arts scholarship. Do you plan to major in music, vocal performance or dance in college? Please list the primary instrument that you play. Years of dance training years of ballet years of pointe years of modern years of jazz Please provide your music experience. Include performance groups and solo experience. Describe your experience and training in your related music field; i.e. recording, performance, musician. SECTION 4: Adversity Please briefly explain each adversity you mark in the space indicated. An explanation is required for each adversity you identify by marking yes. Please be specific in your answers below. You may explain your answers in more depth in Section 5, Question 2. 1. Are you or have you been in foster care or a ward of the state? Yes No If yes, at what age(s) and for how long? Are you in foster care or a ward of the state Yes No right now? 2. Have you ever been homeless? Yes No If yes, at what age(s) and for how long were you homeless? 3. Have you experienced the death, incarceration, or abandonment of a parent/guardian? (Incarcerate: placed in Yes No prison. Abandonment: to cease contact and support.) If yes, please list parent/guardian, cause of death, length of incarceration or abandonment, and your age at the time. 4. Do you live in a household where alcohol or drugs are/were Yes No abused? If yes, please explain the circumstances to the best of your ability and your age at the time. 5. Do you have a physical/mental disability or serious illness? Yes No If yes, please describe your disability or illness. 6. Have you suffered from physical/mental abuse? Yes No If yes, please describe your experience. 7. Do you have critical financial need? (Income < $50,000 annually) Yes No If yes, please describe your experience. 8. Please describe any other adversities you have or are currently experiencing that are not listed above. Please describe in detail the adversities you indicated above and explain how the adversities that you have experienced in your life have motivated you to pursue and complete a college degree. (100-300 words) SECTION 5: Personal Statements Each of the following personal statements is required to complete the application. This section of the application allows you to reveal who you are in your own words including some of your future goals and aspirations. We hope to learn about your motivations and personal attributes that will contribute to your success. You must complete both essays in order for your application to be considered complete. 1. Explain your career goal(s) and the importance of a college education in attaining those goals. (250-350 words) Please type essay below. 2. Personal Mission Statement. The biographies of the members of the Horatio Alger Association offer you examples of people who have chosen to live their lives based on the principles of hard work, honesty, integrity, perseverance, and service to their community. They have also attained success in a variety of ways within the American free enterprise system. Select and read several biographies of Horatio Alger Association members at www.horatioalger.com/members.cfm. Choose a member and explain how you have applied the virtues exemplified in the member’s life story in your own life. Use real life examples from your own experience. (150-200 words) Name of member for essay Please type essay below. SECTION 6: Academic Information We will ask your school to fill out all information related to your academic progress including GPA, test scores, honors classes and class rank. CEEB Code (your school’s ACT/SAT code) Consult your school for this code or go to http://apps.collegeboard.com/cbsearch_code/codeSearchHighschool.jsp. Name of Your High School Counselor Applicant Certification I certify that I will graduate from high school in the spring/summer 2010, and will attend an accredited college or university in the US working towards a bachelor’s degree in the fall of 2010. I certify that I will be attending an accredited college or university in the United States. I understand that falsification of any information may result in the termination of any scholarship granted and that this application becomes the property of the Horatio Alger Association. All information given is held in confidence. I agree to allow the Horatio Alger Association to share my information with Horatio Alger Educational Partners.
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