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! High School Senior/Undergraduate Dependent Scholarship Application Sponsored by the Vandenberg Spouses Club For the 2016-2017 Academic Year THIS IS A PRIVATE ORGANIZATION. IT IS NOT A PART OF THE DEPARTMENT OF DEFENSE OR ANY OF ITS COMPONENTS AND IT HAS NO GOVERNMENTAL STATUS.

I. Awards A. The Vandenberg Spouses Club will award scholarships to eligible individuals who show promise of contributing to their communities. B. The Scholarship Committee considers an applicant s scholastic, community service, special interests, and exceptional qualifications in other areas. C. Financial need will not be a consideration. II. III. IV. Eligibility for Award A. Graduating seniors (including home school), in the class of 2017 and college-age dependents of active duty military sponsors who are stationed at Vandenberg Air Force Base. B. High school seniors and college-age dependents of retired or deceased military are eligible if applicant currently resides in Santa Barbara County or San Luis Obispo County. C. Those students related to current members of the Vandenberg Spouses Club Scholarship Committee, and/or Scholarship Judging Committee are not eligible for this award. D. Applicant s GPA must be 2.5 or higher to apply. Limitations A. Scholarships are not limited to any specific field of study. B. Awards must be used by a full time student in any accredited college, university, vocational or technical school. C. Award must be claimed by 1 May 2018. D. Scholarship must be used for anything in the student s account at the institution during the 2017-2018 school year. E. Payment of scholarship monies will be made directly to the selected school. F. Students accepting an appointment to a service academy, or other full school scholarship (tuition, room and board) become ineligible for this award. In this event, the scholarship will be awarded to a chosen alternate. Application Package Must Include A. Completed application. B. Complete the attached High School Information Form. This form must be verified and signed by student s guidance counselor. C. Transcript of all high school and college grades if applicable. D. A valid military ID must be presented if selected for scholarship. E. Attach essay a. Requirements: At least 400 words, but no more than 650 words. Do not use your name, school, or other identifiers in the essay. Your essay will be evaluated based on content, creativity, grammar/spelling, and structure. b. Question: How has being a military dependent influenced your decision to pursue higher education? F. All scholarship application packages must contain items A-E and be submitted no later than March 20, 2017 to address listed below: Revised October 2016 Vandenberg Spouses Club c/o Scholarship Committee P.O. Box 5514 Vandenberg AFB, CA 93437 Point of Contact: Georgia Jones

Revised October 2016

Personal Information Form APPLICANT INFORMATION Name (last, first, middle): Street Address: Name of High School Currently Attending: City: Graduation Date: State / Zip: Applicant s ID Card Expiration Date: Home Phone Number: Cell Phone (optional): Email Address: SPONSOR INFORMATION Sponsor s Eligibility Category: (Check One) Active Duty Retired Deceased Reservist Sponsor s Name (last, first, middle): Rank/Grade & Branch of Service: Relationship to Applicant: Sponsor s Organization (Duty Station): Current Mailing Address: Organization s Mailing Address: Home Phone Number: Duty Phone Number: Email Address: Signature of Sponsor: Signature of Applicant: Revised October 2016 Page 4! of! 12

It is important that applications provide any and all qualifying information in the application categories (Educational, Employment, Community/Volunteer Service, Community/Club Activities, High School Activities, Awards/Honors) Scholarships are awarded based on total points. Please attach additional data sheets as necessary to gain maximum points. High School Information Form (Undergraduate applicants should complete this section to earn additional points.) EDUCATIONAL DATA High Schools Attended - Grades 9-12 (Name, City, State) GPA Dates Attended From Mo/Yr To Mo/Yr HIGH SCHOOL ACTIVITIES List most recent first. List school athletics, clubs and activities. Activity / Description Grades Participated Revised October 2016 Page 5! of! 12

AWARDS / HONORS Grades 9-12 Begin with most Recent Award / Honor and Organization Description of Award/Honor Grade HIGH SCHOOL COUNSELOR: Please complete the following SAT: ACT: GPA: Grading Scale (Circle One) 5 PT 4PT Class Rank: of Number of Weighted / AP Courses: Counselor s Telephone Number: Counselor s Name: Counselor s Email Address: Counselor s Signature Date Revised October 2016 Page 6! of! 12

Revised October 2016 Page 7! of! 12

It is important that applications provide any and all qualifying information in the application categories (Educational, Employment, Community/Volunteer Service, Community/Club Activities, High School Activities, Awards/Honors) Scholarships are awarded based on total points. Please attach additional data sheets as necessary to gain maximum points. Undergraduate Information Form (This section should only be completed by applicants who have completed at least 1 semester of college courses. This section does not apply to applicants who have not completed High School.) EDUCATIONAL DATA For Undergraduate Applicants Colleges Attended - (Name, City, State) GPA Dates Attended From Mo/Yr To Mo/Yr UNDERGRATUATE ACTIVITIES List most recent first. List athletics, clubs and activities. Activity / Description Year Participated Revised October 2016 Page 8! of! 12

AWARDS / HONORS Undergraduate Begin with most Recent Award / Honor and Organization Description of Award/Honor Year CURRENT AREA OF STUDY: (Optional) Major: Minor: Description: Description: Revised October 2016 Page 9! of! 12

It is important that applications provide any and all qualifying information in the application categories (Educational, Employment, Community/Volunteer Service, Community/Club Activities, High School Activities, Awards/Honors) Scholarships are awarded based on total points. Please attach additional data sheets as necessary to gain maximum points. Community Information Form EMPLOYMENT DATA: From 9 th grade to present. List most recent first. Job Description - (Name, City, State) Estimated Hours Dates Employed From Mo/Yr To Mo/Yr COMMUNITY/VOLUNTEER SERVICE From 9 th grade to present. List most recent first. List volunteer work with service, religious, and other community organizations. Organization (Name, City, State) Position / Title Estimated Hours Dates Volunteered From Mo/Yr To Mo/Yr COMMUNITY CLUB/ACTIVITIES From 9 th grade to present. List most recent first. List nonschool athletics, clubs and activities. Revised October 2016 Page 10! of! 12

Organization (Name, City, State) Position Dates Participated From Mo/Yr To Mo/Yr Certification Form (This section must be completed by all applicants.) I further certify that should I accept a Vandenberg Spouses Club (VSC) Scholarship Award, I will abide by the following: 1. Scholarship funds are to be used within the 2017-2018 academic year for undergraduate studies. 2. All funds received shall be applied to tuition and/or associated university costs administered by an accredited college or university. These costs may include books, fees, room or board but may not be used for penalties or disenrollment fees. 3. As a scholarship recipient, I must provide the name and address of the school I will attend for the 2017-2018 academic year to the scholarship committee no later than 1 July 2017. 4. If I accept an appointment to a military service academy or a full scholarship (to include tuition, books, room and board) I will be ineligible for this VSC scholarship award. 5. I am a responsible citizen in good standing in the school and the community. 6. It is my responsibility to notify the VSC Scholarship Committee of any change of status (e.g., change of schools, change in address, etc.). Failure to do so may result in the forfeiture of my scholarship award. 7. If any of the above conditions are violated, scholarship funds must be returned to the VSC Scholarship Fund. I agree that my signature on this form will authorize the VSC Scholarship Chair to release this application, including GPA and transcript(s) to the Scholarship Committee, as needed. I certify that all information in this application is accurate to the best of my knowledge, and the essay is entirely my own effort. APPLICANT S NAME: Printed: Signature: Date: SPONSOR S NAME: Revised October 2016 Page! 11 of! 12

Printed: Signature: Date: Revised October 2016 Page 12! of! 12