1 DIRECTIONS FOR BHS LOCAL SCHOLARSHIP Online at: Go to: Schools, BHS, then Guidance. NOTE: Application cannot be saved on-line (it may be saved to a jump drive). Read, edit, and print each page as you complete it. You are strongly advised to make a copy of the completed application for your records. Upon completing application: 1. Print a copy & bring it to the Guidance office. You will sign, date, and attach p Submit one copy via to: 1. RECOMMENDATION FORM (Page 2): Print out the Recommendation Form to give to your evaluator. Your Recommender does have the option of filling it out online and giving the signed copy to you or the Guidance staff. Tell them the link is on the BHS website/guidance page. Let your evaluator know what day you will be picking up your recommendation. Be considerate of their time and give them 2 weeks to complete your recommendation. Select one person who is either: (1) not related to you in the community and outside the school setting, (2) an advisor of an activity in or out of school, or (3) a BHS teacher, principal or vice principal. Choose your recommender wisely; only one completed recommendation form is to be included in this packet. 2. PERSONAL ESSAY (Pages 5-6): Do NOT attach a data sheet or resume to this application. Use one or two paragraphs in answering each essay question. 3. VOLUNTEER CERTIFICATION FORM (Page 9 ): This form is a supplement to page 8. If you choose to complete page 8, this form must be completed by an advisor or supervisor of one of your volunteer or community projects. Print out the Certification Form to give to your evaluator. (They do have the option of filling it out online and giving the signed copy to you or the Guidance staff. Tell them the link is on the BHS website/guidance page.) 4. LILLIAN WULBERS MEMORIAL MEDICAL SCHOLARSHIP FORMS (Pages W1 & W2) are filled out ONLY by students majoring in a health profession. Examples of health professions are: pre-med, nursing, physical therapy, ophthalmologist, pharmacist, anesthesiologist, dentist, nuclear medical technician, etc. Or vocational health fields: dental assistant, LPN, radiologic technician, respiratory therapist, operating room technician, etc. 5. The application must be turned in BEFORE the deadline of 4 p.m., Monday, December 2, Early applications are most welcome. APPLICATION CHECKLIST DEADLINE IS 4 P.M. ON MONDAY, DECEMBER 2, 2013 The application must be COMPLETE. Check Here: Cover Page Pages General Activities and Academic information pages Pages Personal Essay pages Pages 7 & 8 -- Volunteer project and Volunteer Certification Form (these pages are optional) Page 9 -- Recommendation Form Page Signature Page (obtain in Guidance office, sign and attach in order) Page W1 and W2 -- Lillian Wulbers Memorial Scholarship Application ATTACH THIS ONLY IF YOU ARE PLANNING TO PURSUE A MEDICAL CAREER!! WHEN YOU TURN YOUR COMPLETED APPLICATION INTO THE GUIDANCE OFFICE, THE ORDER OF PAGES WILL BE: 1, 2, 3, 4, 5, 6, 7, 8 (p. 7-8 are optional), 9, 10, W1 and W2 (Attach W1-2 only if pursuing a medical career.) career). IF YOU HAVE QUESTIONS, SEE YOUR COUNSELOR! GOOD LUCK!!
2 Cover Page BHS LOCAL SCHOLARSHIP PAPER APPLICATION COVER PAGE Guidance Office Use Only If you are selected as a scholarship recipient, this page will be given to the Brookings Register so they can write a correct article about you. The scholarship committees do not see this, SO THIS INFORMATION MUST BE INCLUDED AGAIN IN YOUR ACTUAL APPLICATION. STUDENT S FULL NAME: (Last, First, Middle) PARENT OR GUARDIAN NAME: STUDENT ADDRESS: PHOTO HERE All applications must have a recent photo attached. Headshot only. PHONE NUMBER: DATE OF BIRTH: GRADUATION DATE: May 25, 2014 FIRST CHOICE COLLEGE OR TECH SCHOOL: INTENDED MAJOR: LIST ACTIVITIES YOU ARE IN THIS SENIOR YEAR AND OFFICES YOU ARE HOLDING ACTIVITY OFFICE ACTIVITY OFFICE LIST VOLUNTEER WORK YOU ARE DOING OR HAVE DONE THIS SENIOR YEAR LIST YOUR CURRENT JOB OR MOST CURRENT WORK EXPERIENCE Cover Page
3 IMPORTANT: If your original choice of school changes, tell your Page 1 Counselor, otherwise you may NOT RECEIVE YOUR SCHOLARSHIP, because you may no longer meet that scholarship s specific requirements. BHS LOCAL SCHOLARSHIP PAPER APPLICATION TIME FRAME FOR COMPLETING THIS APPLICATION OCTOBER 1, 2013 DECEMBER 2, 2013 Guidance Use Only SCHOOL OF YOUR CHOICE If you have applied to more than one school, indicate your first choice. IF YOUR FIRST CHOICE CHANGES, NOTIFY YOUR COUNSELOR OR THE GUIDANCE SECRETARY ASAP, OTHERWISE YOU MAY NOT GET YOUR SCHOLARSHIP BECAUSE YOU MAY NO LONGER MEET ITS SPECIFIC CRITERIA. My choice for College or Tech School is: CAREER CHOICE OR MAJOR FIELD OF STUDY Some scholarships require a specific major. You will be considered, where eligible. My Career choice or Major is: Male Female LIST YOUR SENIOR CLASSES 1 ST SEMESTER 2 ND SEMESTER ACTIVITIES IN & OUT OF SCHOOL IN WHICH YOU WERE MOST INVOLVED ACTIVITY GRADE 9,10,11,12 OFFICES HELD President Vice Pres. Secretary Treasurer Activities
4 Page 2 HONORS AND AWARDS IN AND OUT OF SCHOOL State grade (9, 10, 11, 12) you received the award and the name of award or honor. HONOR/AWARD GRADE HONOR/AWARD GRADE COMMUNITY SERVICE PROJECTS OR VOLUNTEER WORK Select those in which you were most involved. ( List individual projects done in 4-H, Scouts, FCCLA, SADD, NHS, Church Youth Group, or things you personally volunteered for and did to benefit our community.) ACTIVITY Date(s) Done Total Project Hours Grade (9-12) ACTIVITY Date(s) Done Total Project Hours Grade (9-12) WORK EXPERIENCE Start with the most recent. EMPLOYER JOB Avg. Hrs per Week Dates Employed Activities
5 Page 3 FINANCIAL AID SECTION IF THERE IS PERTINENT INFORMATION OR EXTENUATING CIRCUMSTANCES WHICH WILL HELP IN ASSESSING YOUR FINANCIAL NEED, PLEASE EXPLAIN ON AN ADDITIONAL SHEET AND ATTACH IT BEHIND THIS PAGE. The TOTAL per year cost of attending my college or tech school will be: Tuition & Fees per Year: Room & Board per Year Have you filled out or do you plan to fill out a financial aid form? Yes No Family members living at home (include yourself) Family members attending a post high school in fall 2013 (include yourself) DO NOT FILL OUT THIS AREA! YOUR COUNSELOR WILL COMPLETE THIS PORTION OF THE APPLICATION AFTER YOU HAND IT IN. COUNSELOR VERIFICATION: RANK IN CLASS: 6 TH SEM NUMBER IN CLASS: 6 TH SEM 184 GPA: 6 TH SEM ACT TEST SCORES (Range from 0-36; scores used through the Dec. 14, 2013 test): English Math Reading Science Composite COUNSELOR SIGNATURE DATE The following questions are needed to fulfill the criteria of specific scholarships. Answer each question. 1. Have you played soccer at BHS? yes no If yes, how many years? Are you planning on playing on a college team? yes no 2. Is either parent/guardian a graduating member of the BHS Class of 1976? yes no If yes, name the parent/guardian : 3. Is either parent/guardian a current member of the Bobcat Backers? yes no If yes, name the parent/guardian : 4. Does a parent or grandparent have a Masonic Lodge affiliation? yes no If yes, name the parent or grandparent : 5. Have you been a member of the BHS Golf Team? yes no If yes, how many years? Academic
6 LIST YOUR HIGH SCHOOL CLASSES AND GRADES Use letter grades, A, B, C, etc., for grade received. Include your Senior classes, leaving grade blank. MATH CLASSES GRADE Sem1/Sem2 SCIENCE CLASSES GRADE Sem1/Sem2 AP CLASSES Page 4 GRADE Sem1/Sem2 FOREIGN LANGUAGE GRADE Sem1/Sem2 ELECTIVES RELATING TO COLLEGE MAJOR GRADE Sem1/Sem2 CTE CLASSES GRADE Sem1/Sem2 HONORS CLASSES VISUAL ARTS CLASSES CTE Career and Technical Education Classes AGRICULTURE DEPARTMENT Intro to Agriculture Ag Mechanics Leadership & Entrepreneurship Horticulture and Landscaping Large Animal Science & Vet Technology Small Animal Science & Ag Processing Biotechnology Project Design & Construction BUSINESS DEPARTMENT Computer Accounting Computer Applications Adv. Computer Applications Business & Personal Law Business Management Business Media Productions Bus. Media Productions Capstone Career Skills & Exploration Personal Finance Youth Internship STEM CLUSTER Introduction to Eng. Design Principles of Engineering Principles of Biomedical Science Sociology Economics Psychology FACS (Family & Consumer Sciences) DEPT. Child Development & Parenting Leadership & Service Learning Nutrition & Foods Interior Design ProStart ProStart Capstone Relationships INFORMATION TECHNOLOGY Computer Programming: Visual C#/C+ Computer Programming: Adv. Visual C#/C+ Computer Programming: JAVA, HTML, JAVA SCRIPT Computer Programming: Adv. JAVA Computer Programming: Visual Basic Computer Programming: Adv. Visual Basic Computer Programming: Graphics Computer Programming: Adv. Graphics Computer Programming: Robotic Computer Programming: Tetrix Academic
7 Page 5 PERSONAL ESSAY USE ONE OR TWO PARAGRAPHS IN ANSWERING EACH QUESTION. 1. Introduce yourself Do NOT use your name and share something you would like the committee to know about you. 2.What are the first words that come to your mind to describe yourself? (ex: energetic, creative, etc.) 3. Which high school class have you liked and benefited from the most and why? 4. What extra-curricular activity was the most valuable to you and why? Essay
8 Page 6 5. What do you think is your greatest strength, talent or quality, and why? 6. What were your main reasons for selecting your post-high school, and what major will you be studying at this school? 7. Reflecting back over your high school years, is there anything you would have done differently? 8. Explain how you are living and will continue to live a healthy and well-balanced lifestyle, taking into consideration academics, spirituality, physical exercise, mental health, enjoyment of the arts and other aspects you think are important to a well-balanced lifestyle. Essay
9 If you choose NOT to complete pages 7 and 8 in your application, please remove them before you turn in your application. Page 7 Volunteer Project Information Filling out this page is NOT mandatory; however, it is used in judging three specific scholarships. If you choose to provide this information, you must also have the project director/coordinator complete the Volunteer Certification Form (page 8 ) and turn it in with your application. NAME ONE COMMUNITY SERVICE/VOLUNTEER PROJECT IN WHICH YOU WERE MOST INVOLVED: Project Name Date Started Date Completed BRIEFLY DESCRIBE WHAT YOUR PROJECT ACCOMPLISHED. WHAT ROLE DID YOU PLAY IN THE PROJECT? WHEN DID THE ACTIVITY START AND HOW LONG DID IT LAST? WHAT WAS THE MOST DIFFICULT PART OF YOUR PROJECT? WHAT DID YOU LEARN FROM BEING A PART OF THIS PROJECT? Volunteer
10 STUDENT REQUESTING EVALUATION: Page 8 Volunteer Advisor: Please complete this certification for the BHS Local Scholarship Program. I will pick up this form on. Your time and effort are appreciated. Thank you! STUDENT: After you pick up the completed evaluator s form, please cut along the dotted line and reattach certification form to application. Access this form online: Go to Schools, then BHS, then Guidance. PLEASE DO NOT USE THE STUDENT S NAME ANYWHERE ON THIS FORM Page 8 BHS LOCAL SCHOLARSHIP VOLUNTEER CERTIFICATION FORM (To be filled out by an advisor or supervisor of a volunteer or community service project.) 1. What was the community service/volunteer project? 2. Advisor or supervisor name (please print) 3. What role did the student play in this project? 4. When did the project start and how long did it last? to 5. Total number of hours student put in on this project? 6. Evaluator: Please rate the student on each of the following regarding this particular volunteer project. BELOW AVG. AVG. ABOVE AVG. EXCELLENT TRULY OUTSTANDING (Top 2-3%) NO BASIS FOR RECOMMEND- ATION LEADERSHIP MOTIVATION SENSE OF RESPONSIBILITY EFFORT CONTRIBUTED 7. How long have you known the applicant? In what capacity? PRINT NAME DATE EVALUATOR S SIGNATURE Upon completion of this form, please sign & date and return to requesting student.
11 STUDENT REQUESTING RECOMMENDATION: Page 9 EVALUATOR: Please complete this recommendation for the Local Scholarship Program. I will pick up this recommendation form on. Your time and effort are appreciated. Thank you! STUDENT: AFTER YOU PICK UP THE COMPLETED EVALUATOR S FORM, PLEASE CUT ALONG THE DOTTED LINE AND REATTACH RECOMMENDATION FORM TO APPLICATION. Access this form online: Go to Schools, then BHS, then Guidance. Page 9 Please do not use the student s name anywhere on this form. BHS LOCAL SCHOLARSHIP RECOMMENDATION FORM Guidance use only EVALUATOR: Please rate the student on each of the following items in comparison with other college or technical school bound students in your classroom or at your place of employment. If you wish to provide any additional information, please use the back of this sheet. BELOW AVG. AVG. ABOVE AVG. EXCELLENT TRULY OUTSTANDING (Top 2-3%) NO BASIS FOR RECOMMEN- DATION LEADERSHIP SENSE OF HUMOR EMOTIONAL MATURITY SELF-DISCIPLINE ORIGINALITY SELF-CONFIDENCE MOTIVATION CREATIVITY SENSE OF RESPONSIBILITY INTEGRITY REACTION TO SET BACK CONCERN FOR OTHERS TOLERANCE OF DIFFERENCES RESPECT ACCORDED BY CLASSMATES (OR OTHER EMPLOYEES) GENERAL INTELLIGENCE/ INTELLECTUAL PROMISE Print Name Occupation Evaluator Signature Date Recommendation form
12 I UNDERSTAND THAT THIS APPLICATION IS FOR BHS SENIORS, AND THAT IT MUST BE COMPLETED IN ITS ENTIRETY AND TURNED IN TO THE GUIDANCE OFFICE BEFORE 4 P.M. FRIDAY, DECEMBER 2, You must pick up Page 10 in the Guidance office, sign it, and attach it to your application.
13 Page W1 LILLIAN WULBERS MEMORIAL MEDICAL COLLEGE OR VOCATIONAL SCHOLARSHIP APPLICATION Application ID. # Fill out this application only if you are planning to enter a health field. EXAMPLES OF MEDICAL CAREERS FOR COLLEGE: Medical Doctor, Nurse, Orthodontist, Dentist, Physical Therapist, Medical Technician, Pharmacist, Athletic Trainer, Cardiovascular Tech, Nuclear Medicine. EXAMPLES OF MEDICAL CAREERS FOR VO-TECH: Dental Hygienist, Dental Assistant, Nurse, Radiologic Tech, Respiratory Therapist. COLLEGE OR TECH SCHOOL THAT YOU PLAN TO ATTEND: FOR WHAT MEDICAL CAREER ARE YOU PLANNING? YOUR ACT SCORE: ENGLISH: READING: SCIENCE: MATH: COMPOSITE: YOUR GPA: LIST SCIENCE CLASSES TAKEN IN GRADES 9-12: LIST OTHER CLASSES TAKEN IN GRADES 9-12 RELATED TO YOUR COLLEGE OR VO-TECH MAJOR: LIST MATH CLASSES TAKEN IN GRADES 9-12: Medical
14 Page W2 TYPE YOUR RESPONSES TO THE FOLLOWING BELOW: 1. EXPLAIN HOW YOU BECAME INTERESTED IN A MEDICAL CAREER. Application ID. # 2. WHY DO YOU WISH TO PURSUE THIS MEDICAL CAREER? 3. HOW HAS THE LAST FOUR YEARS HELPED TO PREPARE YOU FOR COLLEGE OR VOCATIONAL SCHOOL? 4. IN YOUR PURSUIT TO STUDY IN THE MEDICAL FIELD, WHY DID YOU SELECT YOUR PARTICULAR COLLEGE OR VOCATIONAL SCHOOL? 5. WHY DO YOU THINK YOU SHOULD BE SELECTED FOR A LILLIAN WULBERS MEMORIAL MEDICAL OR VOCATIONAL SCHOLARSHIP? Medical