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Application includes:
Complete, thorough answers to requested information

Essay on given topic (500-700 words)


Official Transcript
One Un-Official Transcript Please Remove ALL personal Information (SSN# or Student IDs).
Two Letters of Recommendations 12 page packet
12 page packet

MSBA FutureBuilders Belcher Scholarship Application
General Information

Name (Last, First, Middle):

Address (Street, City, State, Zip):

Email Address:

Nominating School District: K-8?

High School:

Date of Birth:

Name of Parent(s) or Legal Guardian(s):

Address:

Name of Guidance Counselor:

Guidance Counselor Email:

Achievement Scores

SAT: ACT :

Class Rank: Number in Class:

GPA: Scale: Weighted?

Activities/Leadership

Please explain your participation in any of the following activities, including any leadership or service roles.

Honor Society:

Student Council:

Speech/Drama:

Class Officer:

Athletics:

Music:

Clubs:

Others:

High School Honors

What high school honors have you received?

Community Involvement

Please list any out-of-school organizations/activities in which you participate including community service activities as well as any offices you’ve held or honors received.

Jobs

Do you currently hold a part-time job or have you held a summer job? If so, please describe.

Career Goals

What are your career goals?

Essay

Please write and title a 500-700-word essay on the following theme:

Looking back over your high school career, what would your message to your School Board be on improving the education of those that follow you?




Carl Junction High School

Letter of Recommendation Request Form


Periodically, you may complete applications that require letters of recommendation. You should choose individuals to write these letters who know you well, are familiar with your accomplishments and will be able to make positive statements about your ability, character and special talents. You should always give those you ask for letters of recommendation a minimum of one week’s notice.

Student’s Full Name:___________________________________

What is this letter of recommendation being written for? (for example, college admissions (which one?), scholarship application (specific name of scholarship, etc.?)

____________________________________________________________



Recommendation requested from: _________________________

(Circle) Teacher Counselor Employer Administrator Other



Date Requested: ______________ Date Needed: _______________

Please check whichever request applies:

□ Recommendation letter to be mailed to the following address: (provide



complete name and address AND a stamped envelope) __________________________________________________

__________________________________________________

City _______________State _______Zip_________________

□ Recommendation letter to be returned to student in a sealed envelope.



Please provide the following information and complete the student information requested on the back of this form.

Future/career goals:______________________________________

Post-secondary plans--be specific:__________________________

_________________________________________________________

_________________________________________________________

What accomplishment(s) are you most proud of in the following areas?

*academics? _____________________________________________

*personal?________________________________________________

*school/community service?________________________________

List 5 adjectives that you feel best describe you as a person: _________________________________________________________

Have there been (or are there now) any circumstances/adversity that you

believe have had an impact on your academic performance? Y N

If yes, please explain:_________________________________________

___________________________________________________________



___________________________________________________________.

SCHOOL SPORTS, CLUBS, & ORGANIZATIONS

List all activities in which you have participated during high school. Include clubs, teams, musical groups, etc.,

and accomplishments in each.


Club, Organization, Sport, etc.

Years of Participation

Leadership Position / Accomplishment




09

10

11

12























































































































































































































































































































COMMUNITY INVOLVEMENT & VOLUNTEERISM
List all community activities in which you have participated and note any accomplishments

in each. These should be any activities outside of school in which you participated for the

betterment of your community. For example: church groups, clubs sponsored outside the

school, Boy or Girl Scouts, volunteer groups, or community art endeavors.


Community Organization

Years of Participation

Accomplishment




09

10

11

12








































































































































































WORK EXPERIENCE
List below your job/employment experiences, your job title & responsibilities.


Name of Employer

Years of Participation

Job Title & Responsibilities




09

10

11

12

























































Carl Junction High School

Letter of Recommendation Request Form


Periodically, you may complete applications that require letters of recommendation. You should choose individuals to write these letters who know you well, are familiar with your accomplishments and will be able to make positive statements about your ability, character and special talents. You should always give those you ask for letters of recommendation a minimum of one week’s notice.

Student’s Full Name:___________________________________

What is this letter of recommendation being written for? (for example, college admissions (which one?), scholarship application (specific name of scholarship, etc.?)

____________________________________________________________



Recommendation requested from: _________________________

(Circle) Teacher Counselor Employer Administrator Other



Date Requested: ______________ Date Needed: _______________

Please check whichever request applies:

□ Recommendation letter to be mailed to the following address: (provide



complete name and address AND a stamped envelope) __________________________________________________

__________________________________________________

City _______________State _______Zip_________________

□ Recommendation letter to be returned to student in a sealed envelope.



Please provide the following information and complete the student information requested on the back of this form.

Future/career goals:______________________________________

Post-secondary plans--be specific:__________________________

_________________________________________________________

_________________________________________________________

What accomplishment(s) are you most proud of in the following areas?

*academics? _____________________________________________

*personal?________________________________________________

*school/community service?________________________________

List 5 adjectives that you feel best describe you as a person: _________________________________________________________

Have there been (or are there now) any circumstances/adversity that you

believe have had an impact on your academic performance? Y N

If yes, please explain:_________________________________________

___________________________________________________________



___________________________________________________________.

SCHOOL SPORTS, CLUBS, & ORGANIZATION

List all activities in which you have participated during high school. Include clubs, teams, musical groups, etc.,

and accomplishments in each.


Club, Organization, Sport, etc.

Years of Participation

Leadership Position / Accomplishment




09

10

11

12























































































































































































































































































































COMMUNITY INVOLVEMENT & VOLUNTEERISM
List all community activities in which you have participated and note any accomplishments

in each. These should be any activities outside of school in which you participated for the

betterment of your community. For example: church groups, clubs sponsored outside the

school, Boy or Girl Scouts, volunteer groups, or community art endeavors.


Community Organization

Years of Participation

Accomplishment




09

10

11

12








































































































































































WORK EXPERIENCE
List below your job/employment experiences, your job title & responsibilities.


Name of Employer

Years of Participation

Job Title & Responsibilities




09

10

11

12




























































COMPLETE PACKET DUE IN THE CJHS COUNSELING OFFICE BY 3 PM, 12/16/16


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