PHI THETA KAPPA $500 NONRENEWABLE SCHOLARSHIP. APPLICATION DEADLINE: Friday, April 8, 2016, 12:00PM Mr. Fricks office, 121 Wallace Administration

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1 PHI THETA KAPPA $500 NONRENEWABLE SCHOLARSHIP APPLICATION DEADLINE: Friday, April 8, 2016, 12:00PM Mr. Fricks office, 121 Wallace Administration ELIGIBILITY: Must be a PTK member currently enrolled at Northeast. Scholarship may only be used to pay NACC tuition or for supplies in the NACC bookstore. Money will NOT be issued to the student. The scholarship must be used at NACC by the end of Summer Session Application Instructions 1. Ask two of your Northeast instructors (past or current) to fill out the Academic Questionnaire. YOU should fill out the top section before giving the questionnaire to each instructor. The instructors will submit the completed questionnaires directly to Mr. Fricks. They may not be given to you for delivery to Mr. Fricks. It is your responsibility to check with the instructor to make sure that he or she has completed the questionnaire. 2. Complete the application as instructed. 3. Place the completed application in a 9"x12" manila envelope. Clearly print your name in the upper right corner of the envelope. 4. Submit the envelope to Mr. Fricks Office, 121 Wallace Administration, anytime before 12:00PM on Friday, April 8, Applications will NOT be accepted after this deadline. 6. Failure to follow these requirements will result in your application not being evaluated.

2 PHI THETA KAPPA $500 NONRENEWABLE SCHOLARSHIP Application APPLICATION DEADLINE: Friday, April 8, 2016, 12:00PM Mr. Fricks office, 121 Wallace Administration Please type or print all information in blue or black ink. Name Student ID Mailing address Telephone Instructors to whom you gave the Academic Questionnaire: Signature of applicant Date This application must be complete in order to be considered. APPLICATION DEADLINE: Friday, April 8, 2016, 12:00PM Mr. Fricks office, 121 Wallace Administration APPLICATIONS WILL NOT BE ACCEPTED AFTER THE DEADLINE.

3 Name Cumulative GPA at end of Fall Semester 2015 Number of semester hours completed by end of Spring Semester 2016 Do not duplicate information in the following sections. If more space is needed, use another page. Honors and achievements at Northeast (for example, Dean s/president s Lists, honor societies, Who s Who, class favorite): Extracurricular activities at Northeast (for example, SGA, clubs, yearbook staff, committees, unpaid tutoring or other volunteer services): List any Phi Theta Kappa activities in which you have participated: Leadership positions at NACC (for example, officer or committee chair; if you have declared candidacy for an office in any organization for , you may include this information): Community activities and service during NACC enrollment: College major and career plans:

4 In no more than 250 words, explain your most significant educational experience thus far at Northeast Alabama Community College. Restrict your essay to one specific experience--a class, an assignment, an interaction with an administrator, instructor, or staff person which truly transformed the way you think about learning and/or about your future goals. BE SPECIFIC. Do NOT write a general essay about the advantages of attending Northeast or two-year colleges in general. Type your essay, double-spaced, on a separate sheet. Include your name on the first line at the left margin.

5 ACADEMIC QUESTIONNAIRE PHI THETA KAPPA SCHOLARSHIP Student Instructor Course(s) To the Instructor: Please complete the following questionnaire, and return it to Brad Fricks mailbox by Friday, April 8, Earlier replies will be greatly appreciated. This form is an integral part of the student s scholarship application. No consideration will be given without it. All information will be kept in strict confidence. The student will not have access to the completed form. Phi Theta Kappa appreciates your assistance with this important project. Instructions: Please rate this student by writing the appropriate number beside each category. 5 = Outstanding 4 = Above average 3 = Average 2 = Below average 1 = Weak NK = Not Known to This Instructor Attendance Promptness to class Demonstrated academic ability in classroom setting Perseverance in academic work Leadership in class discussion Ability to work cooperatively with instructor Ability to work cooperatively with other students Ability to work independently Promptness in completing assignments Written communication skills Oral communication skills Instructor s prediction of success in academic studies Please Comment (negatively or positively). Use the back if needed. Your comments make a difference! Signature of Instructor Date Place form in B. Fricks mailbox no later than Friday, April 8. Do not return form to student.

6 ACADEMIC QUESTIONNAIRE PHI THETA KAPPA SCHOLARSHIP Student Instructor Course(s) To the Instructor: Please complete the following questionnaire, and return it to Brad Fricks mailbox by Friday, April 8, Earlier replies will be greatly appreciated. This form is an integral part of the student s scholarship application. No consideration will be given without it. All information will be kept in strict confidence. The student will not have access to the completed form. Phi Theta Kappa appreciates your assistance with this important project. Instructions: Please rate this student by writing the appropriate number beside each category. 5 = Outstanding 4 = Above average 3 = Average 2 = Below average 1 = Weak NK = Not Known to This Instructor Attendance Promptness to class Demonstrated academic ability in classroom setting Perseverance in academic work Leadership in class discussion Ability to work cooperatively with instructor Ability to work cooperatively with other students Ability to work independently Promptness in completing assignments Written communication skills Oral communication skills Instructor s prediction of success in academic studies Please Comment (negatively or positively). Use the back if needed. Your comments make a difference! Signature of Instructor Date Place form in B. Fricks mailbox no later than Friday, April 8. Do not return form to student.