NCOBS SCHOLARSHIP APPLICATION INFORMATION STUDENTS NOMINATED FOR THE TRACY FAMILY FOUNDATION SCHOLARSHIP

Transcription

1 NCOBS SCHOLARSHIP APPLICATION INFORMATION STUDENTS NOMINATED FOR THE TRACY FAMILY FOUNDATION SCHOLARSHIP Congratulations! Today marks the beginning of your selection process. The following information provides details for next steps. Once this paperwork is received, the Scholarship Committee at North Carolina Outward Bound will select the youth who will receive the Tracy Family Foundation Scholarships. This Scholarship will cover full tuition. The student will be responsible for a $75 processing fee, clothing/gear and travel costs to and from course start end/location. NEXT STEPS: 1. Complete and submit the Scholarship Application & $75 Processing Fee: Type or print using blue or black ink. Submit the completed application (or all pages labeled in the upper right corner) and $75 check or money order made out to North Carolina Outward Bound to your contact person. The $75 processing fee is refundable only if you are not chosen to receive the scholarship. 2. Once recipients have been selected, the applicant and their parent/guardian will receive a Registration from your Student Services Representative. This Registration notes all your required forms and provides a link to your course webpage. This will be your go to page. Return all your required paperwork by the due date listed in your Registration . Failure to adhere to paperwork deadlines may result in forfeiture of your position on course. We send much of our correspondence via so please continue to monitor your account throughout the application process. 3. Applicant Interview: After you submit your Forms to be Returned, we will conduct a phone interview with you to review the details of the course and answer any questions you may have. 4. Final Approval: The Medical Screener will review all the forms you submitted and, if necessary, may call or you or your parent/guardian. Once the Medical Screener clears your paperwork, you will be notified via phone or . Questions? Please do not hesitate to contact us during our business hours: Monday Friday 8:30 AM 5:00 PM Eastern Time: or studentservices@ncobs.org 2016 T F F App

2 TRACY FAMILY FOUNDATION SCHOLARSHIP PLEASE COMPLETE EVERY FIELD. CHECK APPROPRIATE BOXES WHEN APPLICABLE. PLEASE TYPE YOUR ANSWERS OR, IF COMPLETING BY HAND, USE BLUE OR BLACK INK AND WRITE IN ALL CAPITAL LETTERS. APPLICANT INFORMATION: LAST NAME FIRST NAME omale ofemale o ETHNICITY (optional) CITY STATE ZIP HOME PHONE WORK PHONE CELL PHONE DATE OF BIRTH (MM/DD/YYYY) SCHOOL NAME PARENT/GUARDIAN 1: LAST NAME FIRST NAME RELATIONSHIP TO APPLICANT CITY STATE ZIP HOME PHONE WORK PHONE PARENT/GUARDIAN 2: LAST NAME FIRST NAME CELL PHONE RELATIONSHIP TO APPLICANT CITY STATE ZIP HOME PHONE CELL PHONE

3 CONTINUED COURSE CHOICES Course Number Course Dates Age Range First Choice Second Choice Third Choice Be sure to indicate your top three course choices, in order of preference. If your first choice is full, we will work to place you on your second or third choice. We cannot guarantee that you will get on your first choice, so please make sure your second and third choices do not have date conflicts with other summer activities. Scholarship Acknowledgement and Release of Information O I understand that SHOULD my child receive this scholarship, the award is not secure until all enrollment materials are returned and my application is approved. O I agree to meet all paperwork deadlines and adhere to all standard application review policies. O As a student, I understand that Outward Bound holds its scholarship applicants to a very high standard. I agree to approach this experience with a high level of motivation and complete my course successfully. As a parent/guardian, I agree to support my child in this experience. O I authorize the disclosure of all information in my application, health history questionnaire and medical paperwork to the Tracy Family Foundation. O I have included a check/money order for the $75 processing fee. Please Check: o I (We) Agree Applicant s Signature DATE Parent/Guardian s Signature DATE

4 CONTINUED SHORT ANSWER QUESTIONS Please type your answers thoughtfully and carefully in the provided space. 1. Explain how you and your family selected your three course options. What interests you about each course (ex. dates, activities, course length)? 2. Describe two leadership qualities you possess that will help you be successful on course. 3. Summer school dates often conflict with Outward Bound dates. Is there a chance that you may be required to attend summer school? oyes ono

5 HEALTH HISTORY QUESTIONNAIRE Please answer each question below; leaving questions blank will delay the processing of your application. Please feel free to write additional information if needed. Name: Date of Birth: Student s Age: Height: Weight: 1. Do you have asthma? oyes ono 2. Do you use asthma medication daily? oyes ono 3. Do you have diabetes? oyes ono 4. Do you have any cardiac issues? oyes ono 5. Do you have a seizure disorder/epilepsy? oyes ono 6. Do you have a bleeding or blood disorder? oyes ono If yes, please specify: 7. Have you had any current orthopedic (bone/joint) issues? oyes ono If yes, please specify: 8. Have you been in counseling in the past year? oyes ono If yes, what is/was being adressed? 9. Are you currently in trouble at school or with the law? oyes ono If yes, please describe: 10. Do you have any dietary requirements/intolerances (other than vegetarian), such as vegan or kosher? oyes ono If yes, please describe: 11. Do you have any allergies that require the use of an EpiPen, cause hives or difficulty breathing? oyes ono If yes, please describe: 12. Please indicate your swimming ability: onon-swimmer ocannot swim more than 100 yards omoderate ostrong 13. Is there anything else that would be helpful for OB to know that has not been asked? If yes, please describe: 14. Who is completing this form: 15. Relationship to the student: Acknowledgement I declare that the information provided by me is true and complete to the best of my knowledge. I undertstand that my responses may require follow-up. Applicant s Signature: Date: Parent/Guardian s Signature: Date: