APPLICANT INFORMATION (Please type or request an electronic application) Applicant s Full Name. Please attach. 2x3. Color photo here.

Transcription

1 APPLICANT INFORMATION (Please type or request an electronic application) Applicant s Full Name Please attach 2x3 Date of Birth Color photo here Address City Zip Home/Cell Phone ( ) Applicant s Address (An active address is required) School Grade Cumulative Grade Point Average Parent(s) /Guardian(s) Names Address City Zip Home Phone ( ) Parent(s)/ Guardian address Prospective college wanting to attend (if known) Intended Major/Concentration (if known) Are any of our relatives members of Alpha Kappa Alpha Sorority, Inc.? Yes No If you answered Yes, please write their name(s) and relationship to you. 1 P a g e

2 Please include the following documents along with your application: Sealed Official High School Transcript Two letters of recommendation (non-relative and one teacher or counselor) Non-Refundable $50 application fee made payable to Utah Ivy Foundation due by September 15, 2015 Non-Refundable $300 participant fee made payable to Utah Ivy Foundation due by December 31, 2015 Mail completed application on or before September 15, 2015 to: Utah Ivy Foundation, Incorporated Debutante Cotillion & Scholarship Program P.O. Box Salt Lake City, Utah Or Scan and to: 2 P a g e

3 DEBUTANTE SCHOLARSHIP PROGRAM REQUIREMENTS 1. Once accepted into the Utah Ivy Foundation Debutante & Scholarship Program, a nonrefundable Activity Fee of $300 must be paid in full by December 31, The Utah Ivy Foundation Debutante & Scholarship Program will run throughout the academic school year. Activities will primarily occur on the weekends with some possible evening activities during the school week. a. Do you think you will have time to commit to the program? Yes No (Attendance to all programs/activities is mandatory. There will only be one excused absence allowed.) 3. As part of its fundraising efforts, Utah Ivy Foundation requires each Debutante to commit to fundraising goals during the Debutante program. 4. Do you think you will be able to raise the minimum amount of the financial obligation required to complete the Debutante Program? Yes No (A minimum financial obligation of 10 tickets sold and $600 in sponsorships ads is required.) 5. As part of its community service efforts, the Utah Ivy Foundation requires each Debutante complete a minimum of 20 hours of community service during the Program. Do you think that you will be able to complete the requirement? Yes No 6. Have you been involved in any criminal incidents at school or in the community? Yes No If you answered Yes, please explain the cause and the outcome. 7. Do you anticipate being employed during the upcoming school year? Yes No If you answer is Yes. Please estimate the number of hours and days you will be working. Number of hours Days of Week 3 P a g e

4 EXTRA-CURRICULAR/COMMUNITY INVOLVEMENT Please list specific details for the areas below: School Activities Extracurricular Activities Community Service/Volunteer Activities Honors/Awards ACKNOWLEDGEMNTS & SIGNATURES My signature below indicates that I have provided truthful and complete information in this application. I understand that I may be contacted if there are questions or concerns about my application packet. Applicant s Signature Date Parent/Guardian Signature Date 4 P a g e

5 APPLICANT S ESSAY In words, briefly tell us about yourself. Include your hobbies, future college and career goals and interests. Please explain why you would like to be considered for the Debutante Scholarship Program and what you hope to gain from the experience. A Word Document can be attached with this application if this essay template does not provide enough space for writing. 5 P a g e

6 Please Mail Typed and Completed Application To: Utah Ivy Foundation, Incorporated Debutante Cotillion & Scholarship Program P.O. Box Salt Lake City, Utah Or APPLICANT S STATEMENT OF QUALIFICATION I, confirm that I meet all the Debutante Scholarship Program participation criteria listed below and understand that I must maintain these standards throughout the Debutante Scholarship Season. By submitting a complete application, I understand that I can be dismissed from the Program for not complying with any obligation outlined in the Debutante Program. 1. Achieve High School Junior or Senior classification for the academic school year. 2. Commit to attend all scheduled activities and rehearsals that occur throughout the Debutante Program Season. 3. Demonstrate a focus on goals, aspirations and plans to pursue an education beyond high school. 4. Demonstrate and maintain scholastic achievement each grading period (2.5 GPA or higher). 5. Exhibit commitment to community service with 20 hours minimum performed. 6. Posses leadership potential and good character, which includes but not limited to: a. Must not be a parent or pregnant b. Must not have a criminal, misdemeanor, or court record of any kind c. Must not have poor discipline at school or in the community d. Must not be combative, disrespectful or violent towards anyone in the program Applicant s Signature Date Parent/Guardian Signature Date 6 P a g e

7 Name of Applicant (Please Print) DEBUTANTE SCHOLARSHIP PROGRAM RECOMMENDTION FORM First Middle Last The above candidate has submitted an application to the Utah Ivy Foundation in conjunction with the Upsilon Beta Omega Chapter of Alpha Kappa Alpha Sorority, Inc. to become a participant for the Debutante Cotillion & Scholarship Program and asks that you serve as a character and or academic reference. This Program is highly competitive and while we wish we had room for all applicants, only those applicants with outstanding qualifications will be considered. Your answers should be related to the qualification of the applicant to maintain high academic standards, strive for exceptional personal achievement, and exemplify high moral and attitudes. Please complete and return this form to us in the envelope provide by the applicant. 1. How long have you known the applicant? 2. In what capacity do you know the applicant? 3. What is the applicant s greatest asset? Please respond to the following to the best of your knowledge about the applicant: *(1 = lowest level / 5 highest level) Demonstrates good citizenship 2. Demonstrates high moral / ethical standards 3. Exemplifies respect of authority 4. Gets along well with others 5. Has a pleasant personality 6. Serves as a role model for her peer group 7 P a g e

8 DEBUTANTE SCHOLARSHIP PROGRAM RECOMMENDTION FORM Please explain why you feel this applicant would be an asset to the Debutante Scholarship Program and what she would gain from the experience. A Word Document can be attached with this application if this essay template does not provide enough space for writing. Name & Signature Date Contact Number 8 P a g e

9 Name of Applicant (Please Print) DEBUTANTE SCHOLARSHIP PROGRAM RECOMMENDTION FORM First Middle Last The above candidate has submitted an application to the Utah Ivy Foundation in conjunction with the Upsilon Beta Omega Chapter of Alpha Kappa Alpha Sorority, Inc. to become a participant for the Debutante Cotillion & Scholarship Program and asks that you serve as a character and or academic reference. This Program is highly competitive and while we wish we had room for all applicants, only those applicants with outstanding qualifications will be considered. Your answers should be related to the qualification of the applicant to maintain high academic standards, strive for exceptional personal achievement, and exemplify high moral and attitudes. Please complete and return this form to us in the envelope provide by the applicant. 1. How long have you known the applicant? 2. In what capacity do you know the applicant? 3. What is the applicant s greatest asset? Please respond to the following to the best of your knowledge about the applicant: *(1 = lowest level / 5 highest level) Demonstrates good citizenship 2. Demonstrates high moral / ethical standards 3. Exemplifies respect of authority 4. Gets along well with others 5. Has a pleasant personality 6. Serves as a role model for her peer group 9 P a g e

10 DEBUTANTE SCHOLARSHIP PROGRAM RECOMMENDTION FORM Please explain why you feel this applicant would be an asset to the Debutante Scholarship Program and what she would gain from the experience. A Word Document can be attached with this application if this essay template does not provide enough space for writing. Name & Signature Date Contact Number 10 P a g e