The axa achievement



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THE PROGRAM

The AXA Achievementsm Scholarship offers college scholarships of $10,000 and $25,000 to high school seniors who have demonstrated outstanding achievement in their activities in school, the community or the workplace. The scholarships are sponsored by the AXA Foundation, in association with U.S. News & World Report.


Applicants must -


  • be United States citizens or legal residents,

  • be current high school seniors who plan to enroll full-time in an accredited two-year or four-year college or university in the United States by fall 2011 (enrollment at an accredited postsecondary institution outside of the United States will be considered on a case-by-case basis),

  • demonstrate ambition and self-drive as evidenced by outstanding achievement in an activity in school, the community or the workplace, and

  • be recommended by an unrelated adult who can attest to the student's achievement.


AWARDS

Fifty-two students, to be known as AXA Achievers, will be selected to receive $10,000 scholarships, one from each state, the District of Columbia and Puerto Rico.


From among the state recipients, 10 students will be named national AXA Achievers. They will be selected to receive additional national awards at $15,000 each for a total of $25,000 per national recipient.
AXA Achievementsm Scholarships must be used for education-related expenses for undergraduate study only. Awards are not renewable; however, recipients may arrange to receive payment in installments over multiple years as long as the student continues to enroll in an undergraduate course of study.
Eligible students are encouraged to apply for all AXA-sponsored scholarships, but a student may receive only one AXA-sponsored scholarship. For more information about all AXA Achievementsm scholarships, visit www.axa-achievement.com.
CRITERIA

Applicants are asked to describe in detail an outstanding achievement they have accomplished in a non-academic activity or project. The accomplishment may be a long-term achievement, an activity or a project that occurred in their school, in the community or in the workplace. Primary consideration will be given to the applicant's demonstrated achievement in a non-academic area as reported by the applicant and supported by the appraisal completed by an adult who is not related to the applicant.


Consideration will also be given to other extracurricular activities in school and community, work experience, and the applicant's academic record over the past four years.
Selection of recipients is made by the administrator of the program, Scholarship America, a national nonprofit student aid and educational support organization. The AXA Foundation may participate in the selection of recipients for the national awards. Selection will not discriminate on the basis of race, color, religion, age, gender, national origin or disability. Consideration will be given to select a diverse group of recipients.

APPLICATION


To apply, print the attached application, complete it and have an adult complete the appraisal. Mail the completed, signed application with a current, complete transcript of grades to:

AXA Achievementsm Scholarship

Scholarship America

One Scholarship Way

Saint Peter, MN 56082
Applications and required attachments must be postmarked no later than December 15, 2010. Grade reports are not acceptable. The first 12,000 applications received, which have met the postmark deadline, will be considered.

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APPLICATION, Continued

Applicants are responsible for gathering and submitting all required information in the format requested. Incomplete applications and those not conforming to the required format will be disqualified. Information received is considered confidential and is reviewed only by Scholarship America. The AXA Foundation may participate in the selection of recipients for the national awards. If selected to receive an award, the student must authorize release of scholarship application materials and photographs for use by the sponsor for program promotion and publicity.


All applicants up to 15,000 will be notified by mid-March. Not all applicants to the program will be selected as recipients.
PAYMENT OF SCHOLARSHIPS

Scholarship America will process AXA Achievement scholarship payments on behalf of the sponsors. Payments will be made in equal installments on August 15, 2011 and December 30, 2011 and mailed to each recipient's home address. Checks will be made payable to the school for the recipient’s account.


OBLIGATIONS

Other than as specified, recipients have no obligation to the AXA Foundation and U.S. News & World Report. They are, however, required to supply Scholarship America with complete transcripts when requested and to notify Scholarship America of any changes of address, school enrollment, or other relevant information.


RULES:

Eligibility: No purchase necessary. Employees, financial professionals, or immediate family members of employees or financial professionals of the AXA Group, U.S. News & World Report, Scholarship America, or their affiliates, subsidiaries and advertising and promotion agencies are ineligible to apply.
Application: All sections of the application form and any attachments must be completed in the specified format and include the required signatures. Incomplete applications will be disqualified. The sponsors and Scholarship America will not be responsible for lost, late or misdirected, mutilated, incomplete, illegible or postage-due mail. All applications become the property of the sponsors and Scholarship America and will not be returned or acknowledged. The sponsors and Scholarship America may request additional information or documentation about an applicant. To remain eligible, applicants must provide all reasonably requested documentation and information.
Awards: Awards must be used for education-related expenses at an accredited two-year or four-year college or university in the United States for a full-time course of study. Enrollment at an accredited postsecondary institution outside of the United States will be considered on a case-by-case basis. Full-time study is defined as full-time enrollment for the entire 2011-12 academic year. Awards will be paid in two installments on August 15, 2011 and December 30, 2011 unless a longer payment schedule is requested, up to four years. All checks will be made payable to the school. Taxes, if any, are the sole responsibility of the recipients.
Additional terms: All applicants agree that decisions of Scholarship America are final. To receive the award, recipients agree to authorize release of scholarship application materials and photograph for use by the sponsors for program promotion and publicity. Applicants agree to release, discharge and hold harmless the AXA Foundation, U.S. News & World Report, Scholarship America, and their respective subsidiaries, affiliates, officers, directors and employees, from any and all claims or damages arising out of, in any way, their participation in the program. The AXA Foundation and U.S. News & World Report reserve the right to review the conditions and procedures of this scholarship program and to make changes at any time including termination of the program. Scholarship America, the AXA Foundation and U.S. News & World Report reserve the right to interpret these rules and to make decisions concerning the award, acceptance and use of scholarships in situations not covered by these rules.
Questions about the application process may be directed to Scholarship America

toll-free at 1-800-537-4180 or by email to: axaachievement@scholarshipamerica.org.

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Paper Clip ONLY! Do not staple or put in binder! Page 3 of 6





TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES The first 12,000 applications received will be considered.

If not neat and complete, application will not be reviewed. Application postmark deadline December 15, 2010



FOR

SCHOLARSHIP

AMERICA

USE ONLY


I.D. #




AA

O

RIC/CS

GPA

SATRW

SATM

ACTRE

ACTM

A

W

TOTAL








































APPLICANT

DATA




Last Name       First       Middle Initial   

Permanent Home


Mailing Address       Apartment #      

City       State    ZIP Code      

Telephone (     )         Email Address      


Date of Birth: Month       Day    Year     

CHECK ONE ONLY.

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





CHECK ONE ONLY.

How did you learn about the scholarship? School US News & World Report College Fair PTA



Website (please indicate web address)       Other, explain      

Gender: CHECK ONE ONLY. Male Female

Indicate your status. CHECK ONE ONLY.

American Indian/Alaska Native Black/African American Multi-Racial White

Asian Hispanic/Latino Native Hawaiian/Pacific Islander


PARENT

OR

GUARDIAN

INFORMATION

Last Name       First       Middle Initial   

Address      

Relationship to Applicant       Day telephone (     )        


Email Address       Fax Number (     )        

HIGH

SCHOOL

DATA

Official School Name       High School Graduation Date: Month      Year     


City       State    Telephone (     )     –     



COLLEGE


DATA

Type of college you plan to attend. CHECK ONE ONLY.


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


Year in school next year: 1 Other, explain      


Major or course of study:       Expected college graduation date: Month      Year     
Degree sought: CHECK ONE ONLY. Bachelor Associate Other, explain      


AXAACHV WORD FILLIN 7/10

Copyright © 2010 Scholarship America All Rights Reserved

Page 4 of 6

OUTSTANDING ACHIEVEMENT

Describe in detail one outstanding, non-academic achievement that you accomplished. Your achievement may be an activity or project in school, in your community, or at work. Provide your description on additional sheet(s) of 8 ½ x 11 paper printed on one (1) side. Please do not use a font size smaller than 12 point.


Be sure to print your name and address at the top of each page.
Please be sure to include answers to the following (if applicable) in your essay. Number your responses to each question, so we can identify each answer.


  1. Summarize your outstanding achievement in two to three sentences.

  2. Describe your outstanding achievement in detail.

  3. What did you do to accomplish your achievement? Describe specific planning, goals, and steps including your leadership role to make the accomplishment successful.

  4. What challenges did you face? How did you meet those challenges?

  5. What impact did your achievement have on you personally? What impact, if any, did your achievement have on your family? Your school? Your community?

If space provided in any section is inadequate, you may attach one additional 8 ½” x 11” sheet. Attachments must follow the same format. DO NOT repeat information already reported on the application form. Your name, address and name of this scholarship program should be included on all attachments. Do not send a resumé.



ACTIVITIES,

AWARDS AND

HONORS

List your most important school activities in which you have participated during the past four years (e.g., student government, 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

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

AXAACHV WORD FILLIN 7/10

Copyright © 2010 Scholarship America All Rights Reserved
Page 5 of 6
Applicant’s Name: Last First Middle Initial

TRANSCRIPT

DATA



To the Applicant: You must print this page out and give it to the appropriate school official to complete

and sign the Transcript Data section below.


To the School Official: Please complete the student’s Transcript Data (rank in class, GPA, SAT, and

ACT scores) in the appropriate boxes below, including your signature etc. and return it to the applicant.


IMPORTANT: The applicant must mail the application and all other additional materials in the same

9” x 12” envelope to the AXA Achievementsm Scholarship program address by the postmark deadline of

December 15, 2010.
A complete high school transcript of grades must be sent with this application with a clear explanation of the high school’s grading

scale. Grade reports are not acceptable.




Applicant ranks _______
in a class of __________




Cumulative Grade Point Average




SAT




ACT




Weighted: __________/4.0 scale
Unweighted: ________/4.0 scale




Critical

Reading


Math

Writing




English

Math

Reading

Science

Composite

































School Official’s

Signature Date Title Telephone ( )
School Official’s

Address: Street City State ZIP Code




APPLICATION

CHECKLIST

The student is responsible for submitting all materials to Scholarship America 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 all of the following materials together in one envelope have been received at Scholarship America:




All materials, including transcript, must be

addressed to:
AXA Achievementsm Scholarship

Scholarship America

One Scholarship Way

Saint Peter, MN 56082
Student Application with completed Applicant Appraisal

Current Complete Transcript(s) of Grades

(including grading scale)

Unofficial Student Copy is acceptable.

Grade reports are not acceptable.



All materials, including transcript, are contained in the

same 9” x 12” or similar sized envelope.


Postmark deadline December 15, 2010

CERTIFICATION Scholarship America and the AXA Foundation have the sole responsibility for selecting recipients based on criteria as set forth in the program’s description. This application becomes the property of Scholarship America and AXA Foundation. (It is recommended that you keep a copy for your files.) The sponsors and Scholarship America will not be responsible for lost, late or misdirected, mutilated, incomplete, illegible or postage-due mail.
I acknowledge decisions of Scholarship America are final. I certify I meet eligibility requirements of the program as described in the guidelines and the information provided is complete and accurate to the best of my knowledge. If requested, I will provide proof of information. Falsification of information may result in termination of any award granted.

Applicant’s Signature Date

Parent’s Signature Date
AXAACHV WORD FILLIN 7/10

Copyright © 2010 Scholarship America All Rights Reserved


Page 6 of 6


Applicant’s Name: Last First Middle Initial

APPLICANT APPRAISAL

(REQUIRED)


To the Applicant: You must print this page out and give it to the appropriate individual to complete. The

Applicant Appraisal must be completed by an unrelated adult who is familiar with your outstanding

achievement. Detach this page (6) of the application and give it to the person who will document your

achievement.
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 ½ 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. Describe specifically how the student accomplished his/her outstanding achievement.

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

  3. What challenges did the student overcome?

  4. What extra responsibilities did the student assume?

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


Important: The applicant must mail the application and all other additional materials in the same 9” x 12” envelope to the

AXA Achievementsm Scholarship program address by the postmark deadline date of December 15, 2010.

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 description of achievement? Yes No
You may be contacted to verify information.
AXAACHV WORD FILLIN 7/10

Copyright © 2010 Scholarship America All Rights Reserved





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