Beca Hispanic Leadership Coalition of Northeast Indiana (HLCNI) SCHOLARSHIP APPLICATION 2015

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1 1 P a g e Beca Hispanic Leadership Coalition of Northeast Indiana (HLCNI) SCHOLARSHIP APPLICATION 2015 Latino/Hispanic college students who will be attending or currently are attending any of the colleges and universities in the Indiana who meet the criteria listed below are strongly encouraged to apply for the BECA HLCNI. To apply you must complete the attached HLCNI Scholarship Application and submit, along with all supporting documentation, to: HLCNI Scholarship Committee 9211 Crystal Spring Drive Fort Wayne, IN The amount of each award is $ per year to be disbursed in the amount of $ per semester. This scholarship starts in the fall semester 2015 and recipients may reapply one (1) time as long as all eligibility requirements continue to be met. HLCNI SCHOLARSHIP CRITERIA 1. Must be a student with merit (high school or college academic achievement and community involvement) and must maintain a minimum cumulative GPA of 2.7 on a 4.0 scale. 2. Must submit one recommendation from an adult (preferably an educator, teacher, supervisor or employer) not related to applicant. 3. Must submit an essay of up to 500 words, on the topic found on page 4 of the application. 4. Must attach documentation (i.e. Tax Returns) demonstrating financial need. Please contact the BECA representative if you cannot provide such documents. 5. Must maintain continuous, full- or part-time student status at a regionally accredited notfor-profit college in the state of Indiana (and achieve minimum of 6 credit hours per semester). Students enrolled at or planning to attend a for-profit, non-accredited college are not eligible to receive the scholarship. 6. Must be pursing an Associate s or Bachelor s Degree. 7. Winners MUST attend the Noche de Gala dinner on Saturday, April 18, 2015 in order to be awarded the scholarship. Students who do not attend will be automatically disqualified. The scholarship recipient s ticket for this event will be paid for and sponsored by HLCNI. Any guests wishing to accompany the recipient must purchase their own tickets prior to the event. In order for your application to be considered, you must submit the following documents: 1. Completed application form 2. Official high school transcript or official transcripts for all colleges attended in past academic year Word Essay 4. One (1) recommendation form (attached) 5. Proof of financial need (W-2 s and/or tax return) All documentation should be mailed or ed together as a packet and postmarked by March 15, Incomplete applications will not be reviewed.

2 BECA Hispanic Leadership Coalition of Northeast Indiana (HLCNI) SCHOLARSHIP APPLICATION 2014 BECA HLCNI Scholarship SCHOLARSHIP APPLICATION Check one from each area: First-time Applicant Renewal Applicant Semester(s) of attendance Fall Spring IPFW Ivy Tech University of Saint Francis Indiana Tech Other (Please print or type) PERSONAL INFORMATION D.O.B. NAME: LAST FIRST M.I. PERMANENT ADDRESS: NUMBER STREET CITY STATE ZIP MAILING ADDRESS (If different from Permanent Address): NUMBER STREET CITY STATE ZIP TELEPHONE: ( ) CELL/WORK TELEPHONE: ( ) AREA CODE NUMBER AREA CODE NUMBER ADDRESS: EDUCATION Choose one: Incoming Freshmen: H.S. Attended: Cumulative G.P.A.: Class Rank: College I will attend in : Current College Student: College or University: Cumulative G.P.A.: What major are you pursuing? Circle one: Bachelor Degree / Associate Degree Total College Credit Hours Earned to Date (if any): Year of college entry: Anticipated College Graduation/Transfer Date: 2 P a g e

3 EXTRA CURRICULAR ACTIVITIES Please attach another page if you need additional space Clubs or committees: Responsibilities: EMPLOYMENT Employer: Hours worked per week: Position: VOLUNTEER Organization: Responsibilities: Hours Volunteered per Month: HONORS/AWARDS Academic, Athletic, or Civic Awards: CERTIFICATION I certify that all the information included in this application is true and complete. I hereby grant permission to the Hispanic Leadership Coalition of Northeast Indiana to review my educational records from the institution I am attending or plan to attend to verify my enrollment. Signature _ Date 3 P a g e

4 BECA HLCNI Scholarship SCHOLARSHIP ESSAY 2013 Please write an essay about the topic below. The essay should be typed in Times New Roman 12 font, double spaced, and may be up to 500 words. Please make sure your name is on each page. 1. Imagine you are invited to speak to a group of Hispanic middle school students and their parents about the role of higher education in the Hispanic community. As you write out your speech, consider covering the following: A. Why attend college? B. Three pieces of advice for preparing for college C. Critical resources to take advantage of D. Personal challenges that you encountered, how you overcame them, and what you learned from them. In order for your application to be considered, you must submit the following documents: 1. Completed application form 2. Official high school transcript or official transcripts for all colleges attended in past academic year Word Essay 4. One (1) recommendation form (attached) 5. Proof of financial need (W-2 s and/or tax return) All documentation should be mailed or ed together as a packet and postmarked by March 15, Incomplete applications will not be reviewed. The HLCNI Scholarship Fund does not discriminate on the basis of race, color, age, gender, nationality, religion, or disability with respect to access, employment programs, or services. 4 P a g e

5 BECA HLCNI SCHOLARSHIP 2015 RECOMMENDATION FORM School of Attendance IPFW Ivy Tech Other University of Saint Francis Indiana Tech Applicant s Name Home Address City State Zip Home Phone ( ) INSTRUCTIONS To The Applicant: Please fill in your name and address, and sign the appropriate statement before you submit it to your reference. Please consider using a teacher or professor (who has instructed you in an academic subject for at least one semester during your high school senior year or in a college-level course), a guidance counselor, an employer, a clergy member, or non-family member for a reference. To The Recommender: Please complete side two of this form only after the student has signed the appropriate option. Please attach any additional information you wish to be considered. Please Note: Pursuant to the Family Education and Privacy Act of 1974, the following options are open to you. Please sign one of the following statements before asking your reference to complete this form. Option I I waive the right to see this evaluation form after it is completed. Applicant s Signature Parent s Signature (for applicants who are under 18) Option II I reserve the right to see this evaluation form after it is completed. Applicant s Signature Parent s Signature (for applicants who are under 18) 5 P a g e

6 RECOMMENDER'S EVALUATION Evaluate the student by checking the appropriate columns for each trait listed. Weak Average Strong Excellent Unknown Inquisitiveness Motivation Perseverance Creativity Cooperativeness Responsibility Honesty Leadership Common Sense Adaptability Academic Achievement What other insights or comments do you wish to convey about the applicant? My relationship to the applicant is: Reference Name Occupation address AREA CODE NUMBER Telephone: ( ) Days/Times Available Reference Signature 6 P a g e

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