Stanley Ann Dunham Memorial Scholarship Stanley Ann Dunham Scholarship Application 2011 Application Instructions Please complete the attached application form to apply for the Stanley Ann Dunham Scholarship. Application must be received by February 28, 2011. Late applications will not be accepted. Requirement: Applicant must be a young woman enrolled as a senior at Mercer Island High School. Send your completed application to: Stanley Ann Dunham Scholarship Fund 7683 SE 27th St., #102 Mercer Island, WA 98040-4124 We look forward to receiving your application. The Selection Committee will consider all applications confidential. Sincerely, The Stanley Ann Dunham Scholarship Fund Committee Stanley Ann Dunham Memorial Scholarship Personal Information First Name:_________________ Last Name:___________________________ Address:____________________ Home Phone:_________________________ ____________________ Cell Phone: __________________________ City: _______________________ E-Mail:______________________________ State: _______ ZIP: ___________ Citizenship Status: _____________ Educational Information High School: __________________ SAT Math: ________________________ GPA: ________________________ SAT Verbal: ________________________ Graduation in: ________________ SAT Total: _________________________ Class Ranking: _________________ Please include the following documents: High school and college course (if applicable) transcripts Original essay demonstrating why you deserve the scholarship (see the end of this form) Graded writing sample or portfolio of original work Letters of reference (2). It is recommended that applicants request the letters of reference as early as possible to allow the writer sufficient time to compose quality letters. The finalists may be interviewed by the Scholarship Selection Committee. Stanley Ann Dunham Memorial Scholarship Extracurricular Activities Activity Roles and Responsibilities 1. ___________________ __________________________________ __________________________________ 2. ___________________ __________________________________ __________________________________ 3. ___________________ __________________________________ __________________________________ 4. ___________________ __________________________________ __________________________________ 5. ___________________ __________________________________ __________________________________ Family Financial Information All financial information will remain confidential. Please cross out all Social Security Numbers with a black marker or sharpie prior to submission. Please include one of the following: A. Adjusted Gross Income of Parents or Guardian from previous year's IRS Form 1040 B. Free Application for Federal Student Aid (FAFSA) I hereby certify that the information I have submitted is correct. I authorize the release of this information to members of the Stanley Ann Dunham Scholarship Committee and will provide additional information or verification upon request. If granted the scholarship, I agree to the publication of my name and likeness by the Stanley Ann Dunham Scholarship Foundation and agree to the conditions established by this scholarship. Parent(s)/Guardian(s) Signature: ______________________________________________ ___________________________________________ Applicant’s Signature: ______________________________________________ Date Submitted: __________________________________________________ Stanley Ann Dunham Memorial Scholarship Essay In 500 words or less, tell us why your chosen goals reflect the vision of Stanley Ann Dunham and how you plan to achieve these goals. This vision includes Contributing to productive and respectful intercultural communication Supporting culturally sensitive and appropriate economic, political, and social empowerment of impoverished and oppressed people, especially women Working toward the improvement of the economic and social status of women worldwide Please also discuss any obstacles or challenges you have faced in your life, how you have overcome those and how that contributes to your hope for this scholarship.