SCHOLARSHIP APPLICATION for students currently living in Okaloosa or Walton County and attending the University of Florida in the Fall of 2015 Name: Date of Birth: Address: Telephone: Email: High School: GPA: on a Scale of: SAT Score: ACT Score: Planned Major: Class Rank: Advisor Phone: Advisor Signature: Are you parents members of the UF Alumni Association? Yes No. If yes, please provide your parent s name(s): and UF Alumni Association Id#(s): Scholastic: List all scholastic achievement, honors and awards you have earned. Describe each award or program, your involvement with the program and/or how the award was earned. Please spell out acronyms. You may attach an additional sheet if necessary. Applicant s Name 1
School Activities: List all school clubs and activities in which you participate. Include any positions held, honors, awards or special recognition you have received through your participation. You may attach an additional sheet if necessary. Community Service: List any and all community service you have performed in high school. Please identify the name of the organization with whom you volunteered, the dates you volunteered, the amount of time given to the organization, and describe the service(s) performed for the organization. You may attach an additional sheet if necessary. You may attach a copy of your Florida Academic Scholar Award Record of Community Service Hours instead of listing your community service in this section. Extracurricular: List any extra-curricular activities in which you have participated, not affiliated with the school district. You may attach an additional sheet if necessary. Applicant s Name 2
Employment: List any and all paid jobs you had while in high school. Please identify the name of your employer, your job title, the dates you worked for the employer, the number of hours worked per week, and describe your job duties. You may attach an additional sheet if necessary. Name of Employer: Start Date: End Date: Telephone Number for Employer: Name of Supervisor: Number of Hours Worked Per Week: Job Position/Title: Description of Job Duties: Other Scholarships: Identify any other scholarships you have been awarded including dollar amounts. Other Funding: Identify any other sources of funding for your educational expenses at UF. You may attach an additional sheet if necessary. Applicant s Name 3
Financial Need: Family s Adjusted Gross Income in 2014: Number of Dependents in Family: Ages of Dependents: Number of Dependents Attending College: Father s Occupation: Mother s Occupation: ADDITIONAL INFORMATION REQUIRED TO COMPLETE APPLICATION Your application will not be complete, nor considered, unless you submit the following additional items: A copy of your high school transcript (only 11 th and 12 th grade information is required) A copy of your SAT and ACT scores if not included on your transcript At least one, but no more than two, recommendations from your school At least one, but no more than two, recommendations from someone outside your school A personal statement addressing why you selected the University of Florida, what you hope to accomplish through your education, why the Emerald Coast Gator Club should select you over the other applicants. I HEREBY CERTIFY that all the information submitted to the Emerald Coast Gator Club is true and correct. Dated: Applicant Signature: Upon enrollment at the University of Florida, the chosen recipients will receive a $2,000 scholarship to be divided equally in the amount of $1,000 per semester during their first year at UF. Recipients will not receive any additional funds after their first year. Your completed application should be either emailed to: gbarry@broadandcassel.com or mailed to: Emerald Coast Gator Club Scholarship Committee c/o Ginger Barry Boyd 4100 Legendary Drive, Suite 280 Destin, Florida 32541 Please note that all paper-based submissions must be sent in ONE envelope and ELECTRONIC SUBMISSION IS PREFERRED. All submissions, electronic or otherwise, must be postmarked by April 10 th and should be typed, not handwritten. The committee will notify you of receipt of your application via email and winners will be notified on or before April 30 th. Please contact Ginger Barry Boyd at gbarry@broadandcassel.com with any questions. Thank you for your submission, and Go Gators! Applicant s Name 4
Personal Statement: Use this space to include any other information you would like to submit to the ECGC Scholarship Evaluation Committee. Applicant s Name 5