THE AFCEA EDUCATIONAL FOUNDATION ROTC UNDERGRADUATE SCHOLARSHIP APPLICATION FORM (Photocopies authorized) PERSONAL INFORMATION: Name of Applicant (First name) (Middle initial) (Last name) Applicant s Title (Cadet/Midshipman/O.C.) Brance of Service (CIRCLE ONE) ARMY NAVY MARINE CORPS AIR FORCE U.S. Citizen: Yes No CONTACT INFORMATION: Email Alternate Email Phone at School ( ) - Cell Phone: ( ) - MAILING ADDRESS AT SCHOOL: Address at School (Street Address) (City) (State) (Zip) HOME (PERMANENT) ADDRESS: Home Address (Street Address Permanent) (City) (State) (Zip) Phone at Home (Permanent) ( ) - CURRENT COLLEGE INFORMATION: Applicant s Current College (School name) (City) (State) School where ROTC Unit is Located (School name) (City) (State)
Page 2 ACADEMIC INFORMATION: Applicant s academic status as of March 1, 2009 (circle one): Sophomore Junior Intended Year of Graduation: Degree and Major* being pursued: (* NOTE: Distance-learning programs are not eligible) Grade Point Average (Note: Medal of Honor Scholarship requires 3.0 GPA on 4.0 scale) Please list placement on Dean's List or other recognized honor roll (college only) including total number of semesters earned. Please list any ROTC honors, achievements, leadership roles which should be considered. ROTC UNIT POINT OF CONTACT: ROTC Detachment Point of Contact (POC) (Please list Full Name and Title with Rank/BOS) POC s NAME OF SCHOOL POC s Mailing Address (Street/Mailing Address) (City) (State) (Zip) POC s Telephone Number ( ) - POC s Email (important) EXTRA-CURRICULAR ACTIVITIES - (College Current or Recent Only) Please list student body/class officer positions held (college only) Please list membership in any college organizations/activities such as glee club, drama, debate team, etc.: Please list any college extra-curricular activities (athletics, clubs, etc.), memberships in professional associations, and/or volunteer work with any civic, church or other organizations. Include names, dates and leadership positions held.
Page 3 Please list any athletic participation (college-level only) along with any offices held or special honors received: WORK EXPERIENCES, PERSONAL TRAITS, CAREER GOALS: Explain how your academic and career goals will contribute to the areas related to communications, U.S. intelligence enterprises or national security with relevance to the mission of AFCEA. Explain why you wish to be considered for an AFCEA/Future Heroes EXPERIENCE TOUR placement and what benefit you hope to gain from the experience. (Rising Seniors only) For more information, visit http://www.afcea.org/education/scholarships/rotc/exptours.asp
Page 4 STATEMENT OF FINANCIAL NEED: After demonstrated academic achievement and leadership potential, financial need is important to the Foundation's Scholarship Selection Committee. Please provide a brief financial overview and explain any special needs for financial assistance necessary to completing your undergraduate degree program. THREE LETTERS OF RECOMMENDATION FOR ROTC SCHOLARSHIP: PLEASE NOTE: An AFCEA Waiver Form must accompany ALL letters of Recommendation. Please photocopy attached Waiver Form as needed. 1. At least TWO Letters of Recommendation from current or recent faculty members ARE REQUIRED from all applicants. Please attach the Letters of Recommendation from faculty members having personal knowledge of the applicant's program, achievements and potential. The Letters must each be an original document, printed on school stationery, signed by the faculty member and addressed to Mr. Fred H. Rainbow, Vice President and Executive Director, AFCEA Educational Foundation, 4400 Fair Lakes Court, Fairfax, Virginia 22033. Please note that faculty letters from the applicant s field of study are preferred. 2. One Nomination Letter from the ROTC unit Commanding Officer must accompany all applications verifying the applicant s good standing in the ROTC. The Letter must be an original document, printed on service stationery, signed by the ROTC Commanding Officer and addressed to Mr. Fred H. Rainbow (as above). ADDITIONAL ENDORSEMENTS REQUIRED: 1. Consideration for the Medal of Honor Scholarship requires a stated endorsement from the ROTC Commanding Officer. This endorsement can be part of the Nomination Letter as stated above but MUST be stated in the text. 2. Consideration for the Future Heroes EXPERIENCE TOUR program requires a stated endorsement from the ROTC Commanding Officer. This endorsement can be part of the Nomination Letter as stated above but MUST be stated in the text. FUTURE HEROES EXPERIENCE TOUR CANDIDATES (IMPORTANT PLEASE READ Rising Seniors ONLY): Students interested in being considered for the Future Heroes EXPERIENCE TOUR program and who are selected to participate in summer 2009: information provided in this AFCEA ROTC Scholarship application may be provided to prospective placement agencies. If you elect to have your biographical information released, we will make this information available only to reputable agencies/commands that will be accepting qualified persons for the EXPERIENCE TOURS. The AFCEA Educational Foundation is not responsible for the content of any communication nor any agreement reached between these agencies/commands and you, the applicant. Selection for an EXPERIENCE TOUR will be made by the AFCEA ROTC Selection Committee. By selecting yes below, you indicate your interest in a possible summer 2009 TOUR. YES NO
Page 5 This is to certify that all the information provided in the above application is true to the best of my knowledge. Signature of applicant Date APPLICATION DEADLINE: MARCH 1, 2009 A complete application must include the following and must arrive by appropriate Deadline Date: NOTE: All Letters of Recommendation and/or Endorsement must be accompanied by a WAIVER Form. A completed and signed application form. An official transcript (can be a STUDENT COPY or one endorsed by the ROTC POC). If transfer student, all official transcripts from previous college(s) must be sent by Deadline Date. Two Letters of Recommendation from faculty members ON OFFICIAL LETTERHEAD (can be sent separately, but must arrive by Deadline Date) accompanied by a completed WAIVER Form. At least one Letter of Nomination from the ROTC unit commanding officer accompanied by a completed WAIVER Form. (WAIVER Form attached photocopies authorized) Additional endorsement as required for Medal of Honor or EXPERIENCE TOUR consideration. Please send applications and supporting documents to: Norma Corrales Director, Scholarships and Awards AFCEA Educational Foundation 4400 Fair Lakes Court Fairfax, VA 22033-3899 FAX: (703) 631-4693 Email: scholarship@afcea.org
AFCEA EDUCTIONAL FOUNDATION 4400 FAIR LAKES COURT FAIRFAX, VA 22033 PHONE (703) 631-6149 FAX (703) 631-4693 LETTER OF RECOMMENDATION WAIVER FORM (Photocopies authorized) STUDENTS: Complete and give this form to your recommender along with a stamped envelope with the above address. RECOMMENDERS: Complete and sign Section C. (at bottom of page) then attach this form to your recommendation and send both in the pre-addressed, pre-stamped envelope provided by this student. If the student has waived the right to see your recommendation in Section B. below, please write or type "CONFIDENTIAL" at the top of your letter. NAME OF STUDENT (please print) CLASS YEAR: NAME OF RECOMMENDER (please print) PURPOSE OF RECOMMENDATION: DATE RECOMMENDATION DUE TO AFCEA EDUCATIONAL FOUNDATION: Section A. Consent: In conjunction with the Family Rights and Privacy Act of 1974, I, the above named student, do hereby give the AFCEA Educational Foundation permission to release this letter of recommendation to any person or place designated by me. This consent is to remain in effect until revoked by me in writing. STUDENT'S SIGNATURE: DATE: Section B. Waiver: I, the above named student, waive do not waive any right of access I may have, as provided by law, to this letter of recommendation. STUDENT'S SIGNATURE: DATE: Section C: Recommender Authorization: I do do not authorize use of portions of my letter which may be requested by this student. (Please note: if the student has waived the right to see this recommendation, please write "CONFIDENTIAL" at the top of your letter.) RECOMMENDER'S SIGNATURE: DATE: