Scholarship program



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____________________________________________________________________________________________________________Page 1 of 6
The H. LeBaron Taylor

SCHOLARSHIP PROGRAM

APPLICATION


TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES

If not neat and complete, application will not be reviewed.

The first 100 applications received by postmark deadline April 15, 2010 will be considered.





APPLICANT

DATA

Last Name First Middle Initial


Permanent Home Mailing Address Apartment#


City State Zip Code


Telephone E-mail Address


Social Security Number Date of Birth: Month Day Year


Are you a U.S. citizen? Yes No (circle)

If no, are you a legal U.S. resident? Yes No; status



How did you learn about the scholarship program?



Please indicate (circle): Male Female

American Indian /Alaska Native Black/African American Native Hawaiian/Pacific Islander Multi-Racial Asian Hispanic/Latino White


Are you available for interview? (Circle) Yes No








PARENT OR GARDIAN INFOMATION

Father/Guardian Occupation


Mother/Guardian Occupation


Number of Children in Family Ages




HIGH SCHOOL DATA

Official School Name:


City State Telephone


High School Graduation Date: Month Year





What college or university do you plan to attend?




Have you been admitted? (Circle) Yes No





____________________________________________________________________________________________________________Page 2 of 6




COLLEGE

DATA

Official Name of College or University:




Address:


City State


(Circle)

4 yr. College or University 2 yr. Community or Junior College Other, explain:




Major or course of study:


Expected college graduation date: Month Year


Degree sought: Bachelor Associate Other:






OUTSTANDING

ACHIEVEMENT

ESSAY:


On a separate sheet, type a one-page essay on the topic: “Why I Am Grateful To Be Me.” (Please explain in detail how you expect your college education to make a difference in your future and the community.






TWO LETTERS OF RECOMMENDATION

Submit two letters of recommendation:



  1. One from a teacher, counselor, or administrator.

  2. One from a person in the community (i.e. minister, employer).

Detach page 5 and 6. Give one to each person writing a letter of recommendation.


IMPORTANT:

IT IS YOUR RESPONSIBILITY TO COLLECT EACH LETTER OF RECOMMENDATION AND INCLUDE BOTH WITH YOUR APPLICATION.



____________________________________________________________________________________________________________Page 3 of 6



ACTIVITIES

AWARDS AND HONORS

List your most important school activities in which you have participated during the past four years (e.g., student government, the arts, music, sports, etc.). List all community activities in which you have participated without pay during the past four years (e.g., 4-H, Rotary, hospital volunteer, Special Olympics). Note all special awards, honors and offices held.

Activity

No. of Years Partic.

Special Awards, Honors

Offices Held
































































































































































































































































WORK

EXPERIENCE

Describe your work experience during the past four years (e.g., food server, babysitting, lawn mowing, office work). Indicate dates of employment for each job and approximate number of hours worked each week. List amounts earned at each job.

Employer/Position

From - Mo/Yr

To - Mo/Yr

Hours per Week

Amount Earned



































































































































































































































____________________________________________________________________________________________________________Page 4 of 6



TRANSCRIPT

INFORMATION


This section must be completed and signed by the appropriate school official. An official high school transcript of grades must be sent with this application with a clear explanation of the high school’s grading scale. On-line transcripts and grade reports are not acceptable.

CLASS RANK

GPA

PSAT

SAT 1

ACT





Verbal

Math

Verbal

Math

English

Math



















Cumulative GPA weighted 4.0 scale: (Circle) Yes No

School Official’s Signature: Title


Date Telephone


School Official’s Address:


City State Zip






APPLICATION

CHECK LIST

The student is responsible for submitting all materials on time. Incomplete applications, resumes, and additional information sheets not conforming to the required format will not be evaluated. This application becomes complete and valid only when you have submitted all of the following materials:

Check List




Student Application with completed Applicant Appraisal




School Official Transcript(s) of Grades (including grading scale) On-line transcripts are not acceptable.




Essay




Two Letters of recommendation




All materials, including transcript, are contained in the same 9” x 12” envelope.




All materials, including transcript, must be addressed by March 30, 2008to:

Dr. Kay Lovelace Taylor

11829 East Parkview Lane

Scottsdale, AZ 85255










Postmark deadline April 15, 2010





Applicant’s Signature

Date


Parent’s Signature

Date



______________________________________________________________________________________________________Page 5 of 6




APPLICANT

REFERENCE / APPRAISAL



(REQUIRED)


To the Applicant: Detach this page (5) of the application and give it to the person who will document your achievement: A TEACHER, COUNSELOR OR ADMINISTRATOR.
To the Appraiser: You have been asked to describe your observations of the applicant’s outstanding achievement. Please adhere to the following instructions:
• On an additional sheet(s) of 8 1⁄2 x 11 paper, complete the answers to the questions below.
• Do not use a font size smaller than 12 point.
• Sign your name at the bottom of the appraisal.
• Attach this page to your completed appraisal. Return the appraisal to the applicant. (You

may enclose these pages in a sealed envelope.)




  1. What evidence of setting and achieving goals did the student demonstrate?

  2. What challenges did the student overcome?

  3. What extra responsibilities did the student assume?

  4. How did the student demonstrate initiative and self-motivation?


Important:

  1. PLACE THIS FORM AND YOUR TYPED REFERENCE/APPRAISAL IN A SEALED BUSINESS ENVELOPE.

  2. PLEASE PLACE YOUR SIGNATURE ACROSS THE SEAL OF THE BUSINESS ENVELOPE.

The applicant must mail the application and all other additional materials in the same 9” x 12” envelope by March 30, 2008 to:



Dr. Kay Lovelace Taylor

11829 East Parkview Lane

Scottsdale, AZ 85255



Name of Applicant:


Name of Appraiser:


Title:


Organization:


Telephone Number:



Email Address:


How long have you known the applicant?


In what capacity?

Have you reviewed the student’s application? (Circle) Yes No


You may be called to verify information.

THANK YOU!
____________________________________________________________________________________________________________Page 6 of 6



APPLICANT

REFERENCE / APPRAISAL



(REQUIRED)


To the Applicant: Detach this page (6) of the application and give it to unrelated adult in your community who is familiar with your achievement: (i.e. MINISTER, EMPLOYER, COACH).
To the Appraiser: You have been asked to describe your observations of the applicant’s outstanding achievement. Please adhere to the following instructions:
• On an additional sheet(s) of 8 1⁄2 x 11 paper, complete the answers to the questions below.
• Do not use a font size smaller than 12 point.
• Sign your name at the bottom of the appraisal.
• Attach this page to your completed appraisal. Return the appraisal to the applicant. (You

may enclose these pages in a sealed envelope.)




  1. What evidence of setting and achieving goals did the student demonstrate?

  2. What challenges did the student overcome?

  3. What extra responsibilities did the student assume?

  4. How did the student demonstrate initiative and self-motivation?


Important:

  1. PLACE THIS FORM AND YOUR TYPED REFERENCE/APPRAISAL IN A SEALED BUSINESS ENVELOPE.

  2. PLEASE PLACE YOUR SIGNATURE ACROSS THE SEAL OF THE BUSINESS ENVELOPE.

The applicant must mail the application and all other additional materials in the same 9” x 12” envelope to Dr. Kay Lovelace Taylor



11829 East Parkview Lane

Scottsdale, AZ 85255


Name of Applicant:


Name of Appraiser:


Title:


Organization:


Telephone Number:



Email Address:


How long have you known the applicant?


In what capacity?

Have you reviewed the student’s application? (Circle) Yes No


You may be called to verify information.
THANK YOU!

_____________________________________________________________________________________________________________


H. LeBaron Taylor Scholarship Program


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