2010HAapplication

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					       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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