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SCHOLARSHIP

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SCHOLARSHIP Powered By Docstoc
					                                              D ESCRIPTION
        Fifteen or more $1,000 scholarships are offered to LGBT youth by the Santa Fe Chapter of
                     Parents, Families, and Friends of Lesbians and Gays (PFLAG).

                                        P URPOSE OF A WARD
   To recognize outstanding lesbian, gay, bisexual, and transgender (LGBT) youth.
   To encourage continuing education for self-identified LGBT youth.
   To foster a positive image of LGBT people in society.

                                      E LIGIBILITY & T ERMS
   Priority is given to LGBT youth, however LGBT students up to the age of 35 are eligible to apply.
   Priority will be given to first time recipients. Only past recipients who have received only one Santa Fe PFLAG
    scholarship are eligible (ie you are not eligible if you have received it twice).
   One scholarship designated for a Straight Ally may be available.
   Must attend a post-secondary educational institution within one year.
   Resident of the state of New Mexico.
   Must submit an application (in full, following all directions) with required supporting materials by the application
    deadline.
   Awards will be paid by check jointly to the student and the institution.

                    C RITERIA FOR A WARDING S CHOLARSHIPS
   Affirmation of one's LGBT identity.                        Determination and potential to achieve goals.
   Demonstration of integrity and honesty.                    Demonstration of financial need.
   Participation in community activities.

                                  R EQUIREMENTS & D ETAILS
    Applications will be considered only if ALL of the following is postmarked by March 28, 2011:
    1. Completed Application — original AND three copies
    2. Your most recent transcripts (unofficial is acceptable)
    3. Two recommendations (forms should be sent directly to us by your references)
                             Mail completed application to:
                               Scholarship Selection Committee
                               PFLAG Santa Fe
                               PO Box 32053
                               Santa Fe, NM 87594

   Decisions will be made in early May, 2011.
   Save the date for the Scholarship Award Reception (attendance expected) on Sun June 5, 2011.

     For more information, call Jerry at 438.1164 or Alicia or Eduardo (habla espanol) at 471.4961.
                       You may also e-mail us at scholarship@pflagsantafe.org.
                                                                       2011
                                                                   SCHOLARSHIP
                                                                   APPLICATION
                                                                         MUST BE TYPED
                                                                All Information Is Strictly Confidential



                                  A PPLICANT I NFORMATION
NAME

ADDRESS                                                     CITY/STATE/ZIP

CELL PHONE                                                  EMAIL

BIRTH DATE                   AGE ___    GENDER ______       I IDENTIFY AS (CIRCLE): L G B T A

SOCIAL SECURITY #                                           BIRTHPLACE

PERMANENT MAILING ADDRESS

PERMANENT PHONE NUMBER                                      DO WE NEED TO BE DISCREET?


                                             R EFERENCES
              Have two adults write recommendations for you. Include one family member, if possible.
                           Please use the Reference Form at the end of this application.

                                #1                                               #2
Name

Relationship

Phone

Email

Address




  initials:
                                                                                          Application Page ___ of ___
                    PFLAG S CHOLARSHIP Q UESTIONNAIRE
                  PLEASE TYPE AND LIMIT YOUR RESPONSES TO APPROXIMATELY 150 WORDS


 1. What is the name and address of the school you plan to attend (or schools you have applied to)? What is your
    admission status (planning to apply, applied and waiting for a response, already accepted for admission, etc.)?

      What are your post-secondary education goals (ie major, area of focus, etc?)


 2. How will you finance your post-secondary education (student loans, grants, scholarships, parents, part/fulltime
    employment, etc.)?


 3. What jobs have you held, including volunteer work? What have you gained from these experiences?


 4. What are your interests, hobbies, or extracurricular activities? Choose one and tell what it means to you.


 5. What would you like to be doing ten years from now? How do you plan to achieve this?


 6. What achievement or accomplishment has made you especially proud?


 7. How has the fact that you are lesbian, gay, bisexual or transgender affected you? (If you identify as a
    Straight Ally, please share how being an Ally has affected you).


 8. Are you out to your parents and are they accepting? (If you identify as a Straight Ally, please share one
    experience of when you took action as an Ally (ie, how have you been an ally to others?)).


 9. Please share something else about yourself you want us to know.


 10. How did you find out about the PFLAG Scholarship Program?
      Publication (which one) ______________________ Counselor (name)________________________
      Meeting (which group) ______________________            Internet _______________________________
      Friend* __________________________________              Other (be specific) ______________________
      (*please let us know where friend found out if possible)

 May we mail general information about PFLAG to you? If yes, which address should we use?



 11. I affirm that all information I have provided is true and accurate.



                Signature                                                     Date


initials:
                                                                                             Application Page ___ of ___
                    T RANSCRIPT R EQUEST FOR
                    S CHOLARSHIP A PPLICATION
A PPLICANT
Please fill out this form and give to your high school or post-secondary registrar so that
transcripts will be received by March 28th, 2011. Do not return this form directly to the PFLAG
Scholarship Selection Committee. Transcripts may be unofficial.

Applicant’s Name ______________________________________________________________

Date of Birth _____________________ Social Security Number ________________________


R EGISTRAR
The above individual has applied for a PFLAG Scholarship. Please send an official copy of her
or his transcript by March 28th, 2011 to:
         Scholarship Selection Committee
         PFLAG Santa Fe
         PO Box 32053
         Santa Fe, NM 87594

A signed release of information is provided below.

            


R ELEASE OF I NFORMATION
I, __________________________________________________________________________ ,

authorize the release of my transcripts to the Santa Fe Chapter of PFLAG.


Signature _________________________________ Date _____________________
                                        PFLAG S ANTA F E S CHOLARSHIP
                                            R EFERENCE F ORM
                                                  Please submit by March 28th, 2011


 Parents, Families and Friends of Lesbians and Gays (PFLAG) is a national organization that promotes
 the health and well-being of lesbian, gay, bisexual, transgender and questioning (LGBTQ) persons, their
 families and friends through support, to cope with an adverse society; education, to enlighten an ill-
 informed public; and advocacy, to end discrimination and to secure equal civil rights.

 The Santa Fe Chapter of PFLAG has awarded over $204,000 in scholarships since the inception of our
 local scholarship program in 1997. These scholarships recognize outstanding lesbian, gay, bisexual, and
 transgender (LGBT) youth, encourage continuing education for self-identified LGBT youth, and foster a
 positive image of LGBT people in society.


 NAME OF STUDENT APPLICANT

 YOUR NAME

 ADDRESS                                               CITY/STATE/ZIP

 PHONE                                                 EMAIL


 1. How long have you known and what is your relationship to the student?



 2. Would you recommend this student for a PFLAG Santa Fe Scholarship? Why or why not?
      Are there any specific obstacles this candidate has had to overcome in order to succeed?
      Please feel free to tell us anything else about this candidate you think we should know.
      (Please a separate sheet of paper and do not write on back of application)



Please mail this Reference Form directly to Santa Fe PFLAG, postmarked by March 28th, 2011.
                                 Scholarship Selection Committee
                                 PFLAG Santa Fe
                                 PO Box 32053
                                 Santa Fe, NM 87594


  For more information, call Jerry at 438.1164 or Alicia or Eduardo (habla espanol) at 471.4961.
                    You may also e-mail us at scholarship@pflagsantafe.org.

				
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