Dayton Audubon Society 1375 E. Siebenthaler Avenue Dayton, Ohio

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1 1375 E. Siebenthaler Avenue Dayton, Ohio Dear Applicant, Thank you for your interest in Dayton Audubon's Dick Dively Scholarship. This scholarship, begun in 1982, is designed to help college students (undergraduate or graduate) from the DAS membership area with a demonstrated interest in the environment and/or the natural sciences. Currently, scholarship recipients are receiving a $750 grant for the first year, renewable for a second year. Find enclosed a questionnaire and two personal/academic recommendation forms. If possible, have one of the recommendation forms filled out by a teacher who knows you well. Dayton Audubon would like to have all forms on file by August 5, The scholarship committee will schedule an interview with you shortly thereafter. We will try to complete the process as soon as possible after the interview. If you need any more information, feel free to call. Be sure all correspondence is sent to me at the address below. We look forward to meeting with you. Sincerely, DAS Scholarship Chair Spring Valley, OH oz1221@sbcglobal.net

2 P.O. Box Dayton, Ohio Dick Dively Scholarship Application Submit completed form by August 5, Date of application _ Fill in the blanks as appropriate. Attach a sheet with more detailed responses if necessary. Name _ Phone Social Security Number / _/ Birth date _/ _/ Married / Single Number of dependents High school information: High school City/State Graduation date Approximate rank in class Counselor Extracurricular activities College information: Are you currently attending college? If yes, what is your major? If no, what college do you plan to attend? Have you been accepted?

3 General information: List school, church, community activities: Work experience Where have you worked and for how long? Available finances How do you plan to finance your college education, other than by parental support? List any scholarships or special financial awards received:

4 Parents' information: Parents or guardians Parents' combined annual gross income $ no. of dependents ages Any other children currently attending college? If yes, give names, colleges, and how financed: The above facts are true and correct. We understand intentionally false information will disqualify this application. Applicant signature Parent/guardian signature Please attach or send under separate cover, the following: 1. Two personal recommendations. Use the forms included. 2. A copy of high school or college grades and/or transcript. 3. An essay answering the following question: What are your career goals? How would your reaching those goals support the mission of the National Audubon Society, which is to conserve and restore natural ecosystems, focusing on birds and wildlife, for the benefit of humanity and the earth's biological diversity? Send completed application to : Dayton Audubon Society Scholarship Chair Spring Valley, OH 45370

5 Established 1923 Affiliated with The National Audubon Society in 1969 Personal/Academic Recommendation The Dayton Audubon Society is an environmental organization with a deep and long-term commitment to education. has indicated an interest in the Society's Dick Dively Scholarship that is designed to help college students achieve academic goals in line with the mission of Dayton Audubon. Please write a brief recommendation with pertinent information that will assist us in our decision. Your honest and candid remarks are appreciated. Time you have known the applicant: Relationship to the applicant: Your name Phone This recommendation needs to reach The Dayton Audubon Society by August 5, Send to: Dayton Audubon Society Scholarship Chair Spring Valley, Ohio / oz1221@sbcglobal.net