CARPE DIEM FOUNDATION OF ILLINOIS

Transcription

1 CARPE DIEM FOUNDATION OF ILLINOIS 2012 Scholarship Application INSTRUCTIONS: 1) All application materials must be received in our office by MAY 9, ) Please use ONLY this form when applying. Submitting this application, in no way, guarantees that a scholarship will be granted. There is no appeal, and the decision of the selection committee is final. Only U.S. citizens may apply. 3) Mail via U.S. Mail to: Carpe Diem Foundation of Illinois P.O. Box A3194 Chicago, IL *Use Delivery Confirmation from the U.S. Postal Service or enclose a self-addressed, stamped postcard if you wish to get notice that your application has been received. Mail early to ensure your application is received before the deadline. 4) Send letters of recommendation and an official transcript in sealed envelopes with the application package. It is acceptable to send the transcript separately if your school insists, but indicate on page 1 of the application that it will arrive separately. 5) Enclose check or money order for $10 payable to Carpe Diem Foundation of Illinois to cover processing costs. Please read our Common Questions page online for further explanation. STUDENT INFORMATION: (please print) Name Last First Middle Social Security Number (optional) - - Telephone No. Area Code Number Date of Birth Sex: Male Female Home Address Street Apartment Address G.P.A. of a possible Year of Graduation SAT I: Reading Writing Math ACT: Composite Eng Read Math Sci SAT II: Subject Score Subject Score Subject Score Subject Score College Major/Minor Career Goal(s) Current School School Address Street School Phone Area Code Number Area Code Number School Fax College Counselor Name High School Seniors Only 1

2 STUDENT INFORMATION: (continued) School Year Address If different than home address Street 1 Apartment Street 2 PARENT/GUARDIAN INFORMATION: Mother/Female Guardian Name Relationship to Student Address (if different than applicant) Street Apartment Phone: Home Work Area Code Number Area Code Number Fax Area Code Number Occupation Employer Father/Male Guardian Name Relationship to Student Address (if different than applicant) Street Apartment Phone: Home Work Area Code Number Area Code Number Fax Area Code Number Occupation Employer 2

3 List the schools to which you have applied. If accepted, indicate yes. If you have decided where you will enroll, indicate will attend. This question only applies to high school seniors or for college students transferring schools for the Fall 2012 semester. School: Accepted / Will Attend: Tell us about academic honors and scholarships you have won. For both, include the date of award and the monetary value, if applicable. If you must use additional space, write no more than one-half page on an additional sheet Create a spreadsheet like the one below to describe your extracurricular, volunteer, research and work activities. DO NOT EXCEED TWO PAGES. Activity Grade Levels Hours Weeks Positions held, honors 9, 10, 11, 12 per wk per yr. won, letters earned Sample: Create your spreadsheet on a separate page. 3

4 HONOR STATEMENT AND AUTHORIZATION: Please read and sign. I UNDERSTAND THAT IF I AM SELECTED AS A WINNER, I WILL BE REQUIRED TO PROVIDE MY SOCIAL SECURITY NUMBER AND A PHOTO. I ALSO UNDERSTAND, AGREE, AND HEREBY GRANT PERMISSION TO THE FOUNDATION TO USE A PHOTO OF ME, EXCERPTS OF MY APPLICATION AND SUPPORTING MATERIALS ON THE FOUNDATION S WEBSITE AND IN ITS PROMOTIONAL MATERIALS. I HEREBY CERTIFY THAT THE ANSWERS AND STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE. I ALSO CERTIFY THAT THIS APPLICATION, INCLUDING SHORT ANSWERS AND ESSAYS, IS MY OWN WORK. I UNDERSTAND THAT I MAY BE DISQUALIFIED FROM THIS SCHOLARSHIP IF ANY STATEMENTS OR DOCUMENTS HAVE BEEN INTENTIONALLY FABRICATED. Signature Date How did you learn about our Scholarship Program? 4

5 ESSAY QUESTIONS: Your responses should be typed and then attached to your Scholarship Application. Be sure to provide your full name at the top of each page. Answer questions 1 and 2 in 200 words or less. Answer question 3 in 500 words or less. 1. Discuss an activity or accomplishment that is or was important to your development as an individual. 2. Tell us about your family, especially with regard to service occupations and/or involvement in community organizations. 3. Write an original essay explaining why you have chosen your course of study. You may include comments about both your academic interests and your professional/career goals. If you have not decided on a course of study, write about your unique vision for the future and how you plan to achieve it. ADDITIONAL INFORMATION (optional): Music Scholars Submit the following: A CD or DVD of a musical performance, and/or an original musical composition. CDs and DVDs will not be returned. Theatre Scholars Submit the following: A VHS tape or DVD of a dramatic performance, and/or an original play. Tapes and DVDs will not be returned. Art and Creative Writing/Poetry Scholars Submit a CD, portfolio or website location displaying your work. If you submit a portfolio and wish to have it returned, include a self-addressed, stamped envelope with your application packet. PLEASE PUT YOUR PAGES IN THIS ORDER: 1 - Application pg Application pg Application pg Academic honors and Scholarships page (if you choose to submit one) 5-(6) - Your Activities Spreadsheet in the format given. Use one or two pages, no more. 7 - Application pg Responses to essay questions COMPLETED APPLICATION CHECKLIST: Application Form Answers To Essay Questions Official Transcript (in sealed envelope within application packet) Teacher Recommendation Form (in sealed envelope within application packet) Community Service Recommendation Form (in sealed envelope within application packet) $10 Check made out to Carpe Diem Foundation of Illinois to cover processing costs Music, theatre, art or creative writing/poetry materials (optional) 5

6 CARPE DIEM FOUNDATION OF ILLINOIS Teacher Recommendation for Scholarship To the Applicant: Please fill in the top section of this form and give it to the teacher who will recommend you. Applicant Information: Name Last First Middle Social Security Number (optional) Date To the Teacher: Please provide a candid evaluation of the applicant by completing the appraisal form below comparing the applicant s abilities to other students you have taught and by submitting a letter of recommendation. What, in your judgment, makes this applicant unique? Give particular attention to intelligence, creativity, and capacity for intellectual development. Also, please appraise this applicant s potential in his or her field of study. Return the form and letter to the student in a sealed envelope so that he or she may include it in the complete application package. Your comments are given serious consideration by the evaluation committee. The deadline for receiving this material from the applicant is May 9, Originality Exceptional Outstanding Excellent Very Good Average N/A Initiative Ability to be analytical or critical Ability to communicate orally Ability to communicate in writing Level of enthusiasm and curiosity Thoroughness in carrying out tasks Maturity In my years of teaching, I would rank this student in the top % of students I have taught. Teacher Signature Name (Please Print) Address School School Telephone Number Area Code Number 6

7 CARPE DIEM FOUNDATION OF ILLINOIS Community Service Recommendation for Scholarship To the Applicant: Please fill in the top section of this form and give it to the individual who will write your recommendation. The recommender you select must be an adult with whom you have worked extensively and who knows your capabilities. Do not choose a high school teacher unless he or she has direct knowledge of your service to the community. Your recommender may not be a member of your family. Applicant Information: Name Last First Middle Social Security Number (optional) Date To the Recommender: We would like your candid evaluation of the applicant relative to other students you have known or who work as volunteers in your program(s). Use both this form and write a letter of recommendation. Return the form and letter of recommendation in a confidentially sealed envelope to the applicant so he or she can include it in the complete scholarship packet. What, in your judgment, makes this applicant unique? Give particular attention to intelligence, creativity and capacity for intellectual development. Your comments are given serious consideration by the evaluation committee. Our deadline for receiving this material from the applicant is May 9, Recommender s Personal Information: (Please Print) Name Last First Middle Address Street Apartment Daytime Phone Occupation Employer Relationship to Applicant How many years have you known the applicant? Less than 1 year 1 to 3 years More than 3 years 7

8 Community Service Recommender s Questionnaire: Rate the applicant according to the following variables by putting an X in the appropriate blank. Please use the extraordinary rating only for exceptional performance, for example, for a student who is the best you have seen in five years. A. Demonstrated leadership experience/potential. Consider the following: Has the applicant shown interest in taking on leadership roles? Has the applicant shown good judgment? Does he or she seem confident in handling new situations or challenges? BELOW AVERAGE AVERAGE ABOVE AVERAGE VERY GOOD EXTRAORDINARY B. Service/community ethic. Consider the following: Has the applicant shown a desire to serve others and contribute to the larger society in service clubs, community groups, religious organizations, athletics, political activities, student government, employment or other activities? Has the applicant been involved in a community service, employment, extracurricular activity, or leadership activity? Has he or she accomplished specific goals within the community? BELOW AVERAGE AVERAGE ABOVE AVERAGE VERY GOOD EXTRAORDINARY C. Evidence of selection by, or influence on, peers. Consider the following: Do others look to the applicant to set the tone for a social group? Is his or her advice often sought by peers? Is he or she often selected as a representative, whether in an informal group or in an election? Does the applicant inspire trust in others? Has the applicant served as a mediator in disputes among his or her peers? Does the applicant show an ability to motivate and influence others? BELOW AVERAGE AVERAGE ABOVE AVERAGE VERY GOOD EXTRAORDINARY D. Goal-setting. Consider the following Does the applicant set realistic long-term goals and manage the steps to attain them? Does he or she accept positive and negative feedback with equanimity and use this feedback to alter behavior? Does the applicant show signs of persistence and resolve in following through with projects and responsibilities? BELOW AVERAGE AVERAGE ABOVE AVERAGE VERY GOOD EXTRAORDINARY Signature Name (Please print) Community/Volunteer Position Address Telephone Number Area Code Number 8