2015 als/Cancer Awareness Committee Scholarship Application
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| 2015 ALS/Cancer Awareness Committee Scholarship Application
The ALS/Cancer Awareness Committee is pleased to announce the following $500 scholarships available to local graduating seniors with a minimum GPA of 3.0. Please read the criteria carefully before applying for each scholarship. Applicants may only receive one of the scholarships, but may apply for more than one. Applicants must be enrolled or intend to enroll in an accredited university or technical school, pursue a program of one year or more, and carry at least twelve (12) credits/semester. A minimum GPA of 3.0 after first semester of college is required to receive scholarship money. The Tom Zinda Memorial Scholarship will be awarded to an individual who plans to pursue a post-high school education in agriculture or business. Applicants must be a graduating senior from Almond-Bancroft High School or Amherst High School. The Eugene Shulfer Memorial Scholarship will be awarded to an individual who plans to pursue a post-high school education in the music or medical field. Applicants must be a graduating senior from Iola High School or Portage County High Schools. The Diana Fox-Loesl Memorial Scholarship will be awarded to an individual who plans to pursue a post-high school education in the business field. Applicants must be a graduating senior from Tri-County High School. The Father Dan Farley Memorial Scholarship will be awarded to an individual who plans to pursue a post-high school education in the seminary or medical field. Applicants must be a graduating senior from a Portage County High School or is a graduating senior that is a member of the St. Maximilian Kolbe parish. The Robert “Bobby” Gavin Memorial Scholarship will be awarded to an individual who plans to pursue a post-high school education. Applicants must be a graduating senior from Almond-Bancroft High School, Amherst High School or the Stevens Point Area High Schools. Please check the scholarship(s) for which you are applying: ________: Tom Zinda Memorial Scholarship ________: Eugene Shulfer Memorial Scholarship ________: Diana Fox-Loesl Memorial Scholarship ________: Father Dan Farley Memorial Scholarship ________: Robert “Bobby” Gavin Memorial Scholarship Personal Data: Applicant’s Name: ______________________________________________________________________ Address: ______________________________________________________________________________ City: _____________________Zip Code: ______________ Telephone Number: ____________________ Email Address: _________________________________________________________________________ Name of high school from which you will graduate: __________________________________________ Possible fields of study: ___________________________Approximate length of program: __________ Career or professional plans: _____________________________________________________________ Academic Data: Standing in graduating class: __________ out of __________ students. ACT or SAT Composite or Total Score: ________ Accuplacer Composite or Total Score: __________ Other (specify test): ____________________________________________________________________ Cumulative GPA (at the end of last term): __________________________________________________ *Please include a current copy of your transcript from the institution that you will be graduating high school. Briefly list or describe any scholastic distinctions or service honors you have won in the past 4 years. Extracurricular Activities: Please list your principle extracurricular activities for the past 4 years in order of importance to you. ACTIVITY YEARS PARTICIPATED POSITIONS HELD (if any) _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ Personal and Community Activities: Please list your principle interest, hobbies, or volunteer activities from the past four years in order of their importance to you. ACTIVITY YEARS PARTICIPATED POSITIONS HELD (if any) _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ _____________________ 9 10 11 12 ____________________________ Work Experience: Please list the jobs (beginning with the most current) you have most recently held. Include summer employment and any other experiences you may have had. (ie. Work study) DATES OF INVOLVEMENT JOB/EXPERIENCE EMPLOYER/SETTING OR EMPLOYMENT HOURS/WEEK ____________________ ____________________ _______________________ ____________ ____________________ ____________________ _______________________ ____________ ____________________ ____________________ _______________________ ____________ ____________________ ____________________ _______________________ ____________ Personal Essay: Please include a short personal essay that includes the following information: Name Where are you attending college, what program/major are you planning on pursuing and why have you chosen this field of study? What do you hope to contribute to society through receiving the above education? Financial Information: Number of household dependents ___________ Are any other dependent members of your household pursuing higher education at this time? Yes ___________ No _____________ If yes, please elaborate. ___________________________________________________________________ ________________________________________________________________________________________ Briefly describe any other major scholarship awards, grants, or assistance you will be receiving to help finance your education plans. _______________________________________________________________ _________________________________________________________________________________________ Letter of Recommendation: Please include a letter of recommendation from a non-related adult. List the person you have asked to write a recommendation. NAME TYPE OF RELATIONSHIP ADDRESS AND TELEPHONE # ________________________ __________________________ ________________________________ I certify that to the best of my knowledge the above stated information is accurate. _____________________________________________ APPLICANT’S SIGNATURE If the applicant is under 18, the applicant’s parent (or legal guardian) must also certify with a signature. ______________________________________________ PARENT/GUARDIAN’S SIGNATURE Application materials need to be post marked no later than May 18th, 2015. Please send application materials to: 2015 ALS/Cancer Awareness Committee Scholarships Attention: Janet Glodowski 3826 Smokey Road Stevens Point, WI 54482 For questions call/email: Janet Glodowski 715-824-2525 DLGJLG@wi-net.com Scholarships will be awarded by May 22nd, 2015, and they will be presented to the recipients at the “Superfundaboomalastic 5K ALS Walk/Run and BLAST” on Saturday June 13th, 2015 at 6:30 p.m. Recipients are highly encouraged to attend and volunteer the day of the benefit. Go to www.smokeyexpress.com to see more details. 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