At least four (4) - $1000 scholarships will be awarded to at least two male and two female recipients.

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1 A T H L E T I C B O O S T E R C L U B S C H O L A R S H I P The Tompkins Athletic Booster Club is proud to be able to help our young athletes succeed in their academic pursuits. All student athletes with membership in the booster club are eligible regardless of the sport they engaged in or their success in that sport. Scholarships are awarded to senior athletes who best exemplify the traits of effort, dedication, commitment and spirit regardless of their position or accomplishments on the team. It recognizes the athlete whom the team could count on to give his or her best effort at practice, pitch in to help with team needs, encourage teammates to excel but was not necessarily the star of the team. Applicant s names will not be revealed to the scholarship committee evaluating the applications and making the final decisions. The winners will be announced at the Senior Awards Ceremony on May 23, Applicants must return the completed packet to the front desk, addressed to the Athletic Booster Club by March 31, Please DO NOT staple your application. At least four (4) - $1000 scholarships will be awarded to at least two male and two female recipients. The eligibility requirements are: Athlete/family was a member of the OTHS-ABC for at least three (3) of the four (4) years attending OTHS, with the exception for an athlete who has moved into the district, then eligibility will be based on attendance at OTHS. Athlete is presently a senior and participates in athletics at OTHS Athlete plans to attend a college, university or trade school following graduation Athlete has a minimum GPA of 2.5 Athlete has no athletic, academic (this does not include progress report grades) or behavioral suspensions or probations Athlete has completed: (A) scholarship application with signature from Counselor indicating a clear disciplinary record, (B) administrative evaluation, (C) essay, and (D) questionnaire (E) GPA verification form. Athletes who have received a full scholarship to any college or university will NOT be eligible to receive one of these scholarships. The award may be applied toward tuition, registration fees, books, dormitory fees, or any other college fees or academic expenses. STUDENT STATEMENT: I have read the requirements pertaining to the Booster Club Scholarship Program and completed all necessary forms. If I am awarded a scholarship and change my enrollment at my designated institution, I will inform the Booster Club President about the change of plans in order for the booster club to determine if the scholarship will be withdrawn due to non-enrollment in an accredited institution. I certify to the best of my ability that the information here is complete, true and accurate and that any falsification of information will result in my being declared ineligible. Signature of Applicant Date of Application PARENT OR GUARDIAN STATEMENT: I have reviewed the application and to the best of my knowledge, all information is true and accurate. Signature of Parent or Guardian Date

2 Scholarship Application Form Name: Address: Phone: Parent s Names (or Booster Club representative): Student ID#: School/College/University planning on attending: Have you been accepted? YES NO Major or Career field: High School GPA: Class Rank: Have you ever been on Academic OR Behavioral probation? YES NO Starting month & year at OTHS: Signature from Counselor (indicating clear disciplinary record): Counselor Name: Signature:

3 Administrative Evaluation Form Submit this form to the coach, teacher or administrative personnel you would like to complete it. They should complete this form and submit it to the Athletic Booster Club mail box at OTHS in a sealed envelope. Athlete s Name: Coach s/teacher s Name: Please evaluate each characteristic of the student athlete with 0 being the lowest and 5 being the highest score. Circle the appropriate number: Punctuality: Positive role model: Cooperation: Positive attitude: Commitment: Discipline: Team player: Dedication: Reliability: Responsibility: Sportsmanship: Coaches/Teachers Signature: Date: Comments: Coaches/Teachers: Please place this in a sealed envelope in the booster club mailbox. Do not return this to the student.

4 Essay In 500 words or less, explain what participating in Falcon Athletics has meant to you. Submit typed, double spaced essay with your application. Questionnaire List your athletic participation while attending OTHS: List any academic or athletic honors or awards: List any extracurricular activities you participated in during high school, including community service or work related: From the lists above, what accomplishments are you most proud of and why: What is your favorite OTHS memory:

5 GPA Verification Form I certify that has a minimum GPA of 2.5. Counselor Signature: Date: