All-USA Academic Team Scholarship Checklist Due October 30 th Community College Information (total credits, career goals, GPA, major, etc.

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1 All-USA Academic Team Scholarship Checklist Due October 0 th 05 Personal Information Proof of Citizenship Community College Information (total credits, career goals, GPA, major, etc.) Question A-Outside Obligations Question B-Awards Question C-Community College Attendance *Include word count Question D-Biography *Include word count Question E-Short-term/Long-term Goals Campus Organizations Community Activities Unofficial Transcripts from all Maricopa Community Colleges *Addendum is optional Most Significant Community College Endeavor Essay*Include word count Letter of Recommendation (Leadership Letter Hardcopy)*recommended to ask for an electronic copy in addition Letter of Recommendation (Academic Letter Hardcopy) *recommended to ask for an electronic copy in addition

2 Overview and Eligibility: The printed transcript(s) may be unofficial. Transcripts are used to verify your GPA. GPA is reviewed at the point of application. If your transcript shows remedial or developmental courses (e.g. Pre-Algebra or Basic Writing, usually characterized as being below 00 level coursework), those courses and grades may be removed to determine your cumulative GPA and total number of completed credits. You must maintain a.50 GPA or higher through the Spring 06 semester to remain eligible. To be considered for the All-USA Scholarship, your transcript must show that you have completed 6 semester (or 48 quarter) college-level credits by December, 05 and 48 semester (or 7 quarter) college-level credits by August 0, 06. First Name: Last Name: Mailing Address: City: State: Zip or Postal Code: All-USA Academic Team Scholarship Application Due October 0 th 05 Primary Phone (Cell Phone Number should be entered if one exists): Secondary Phone (optional): Date of Birth: Are you a Phi Theta Kappa Member? (Please use an address that will follow you if you move (i.e. gmail, yahoo, etc.). An address given to you by your community college typically will expire when you leave the college): Are you the first member in your immediate family to enroll in college (neither of your parents have more then a high school education)?: For survey purposes, what is your household/family income? Please include pre-tax wages or salaries. Answers will be kept confidential and judges do not review income as a consideration for scholarship: Gender: Race: Citizenship: You will be requested to provide proof of citizenship. Acceptable documents for U.S. Citizens include either a passport or a birth certificate. International Students must submit a copy of their Visa and an I-0. Students in Canada or other sovereign nations will be notified of appropriate documents to submit. If you indicate that you are not a U.S. Citizen, you must provide a copy of one or more of the appropriate document(s) listed below to verify

3 your status as it pertains to the designation you indicate: Acceptable documents are restricted to the following: Foreign Passport with I-55 stamp Alien Registration Card (I-5 or I-55) Work Permit (45-I) Reentry Permit (I-7) Temporary Resident Card (I-688 not I-688A or I-688B) Refugee Travel Document (I-57) Unexpired I-94 card with one of the following stamps: o Refugee o Asylee o Cuban-Haitian Entrant o Indefinite Parolee o Humanitarian Parolee International students must provide a copy of their visa and I-0 Current Community College: Current Major at Your Two Year College: Current Degree You Expect to Receive at the Community College: Total College Level Credits Already Earned: Number of Credits You Are Taking This Semester (or Quarter): Semester or Quarter Hours: Cumulative GPA? (Include all college-level coursework in the past 5 years, fall 009-present, even if at multiple institutions. GPA is evaluated at the time of application. You must maintain a.50 or higher GPA at the end of Fall 0 semester to remain eligible for national scholarships.): Will you be enrolled at a two-year or four-year college for fall semester (quarter) 04? (To be considered for the Coca-Cola Community College Academic Team, you must be enrolled at least part-time at a two-year or four-year college for the fall 0 semester. Students must be enrolled part-time or full-time at a four-year college to be considered for the Guistwhite Scholarship, the Calhoun Transfer Scholarship, and the GEICO Pathway to Completion Baccalaureate Scholarship, and full-time at a four-year college to be considered for the Hites Transfer Scholarship. Other programs such as the All-USA Community College Academic Team or the New Century Scholars do not require you to be enrolled for fall semester 04.): When Do You Expect to Transfer to a Four-Year College: Anticipated Major at the Four-Year College (if not transferring, enter N/A): Career Goal: Highest Degree Overall You Hope to Obtain: How did you hear about this scholarship opportunity?

4 Discussion Question A Outside Obligations If applicable, describe up to three obligations, which include family responsibilities, employment, or other nonvolunteer obligations you have while attending community college. Do not include campus or community activities that you will include in other sections. Be sure to list your activities in priority order, with the first activity being your most significant. If you do not have any outside obligations, you do not need to complete this question and may move to the next section. : Activity/Position Dates Participated Hours/Week Paid Position Short Summary of Activity Discussion Question B - Awards If applicable, list up to three awards, scholarships or special recognitions that you have received while enrolled at your community college. List your most significant award first, including the name of the award and the date received. If you do not have any awards or recognitions, you do not need to complete this question and may move to the next section. : Award/Recognition Received Date Received Short Summary of Award (Max of 50 words)

5 Discussion Question C - Community College Attendance Why did you choose to attend a community college? Required, may not exceed more then 50 words. Answer: Discussion Question D - Biography Please provide, in your own words, your biography in a short paragraph. Feel free to include any significant life events or experiences to give judges a broader understanding of what motivates you. Required, may not exceed more then 50 words. Answer: Discussion Question E - Short-term/Long-term Goals What are your short-term and long-goals in each of the following areas:. education,. career,. service/volunteerism. Required, may not exceed more than 50 words. Answer: Campus Organizations: List no more than three community college organizations in which you have participated. Include dates, leadership positions held, time spent (hours/week), plus specific activities or duties performed and scope or impact of your work. Do not include activities listed in other sections. Do not include web links or photographs as these will be removed prior to judging. If you do not have any community activities, you do not need to complete this question and may move to the next section. Please note that a competitive application will most likely have content in all sections. : Campus Activity Dates Participated Hours/Week Leadership Position Held? If Yes, Describe. Paid Position? Describe Participation Duties and/or Impact.

6 Community Activities: List no more than three community activities in which you have participated since you have been enrolled in community college. Do not include activities listed in other sections. Do not include web links or photographs as these will be removed prior to judging. If you do not have any community activities, you do not need to complete this question and may move to the next section. Please note that a competitive application will most likely have content in all sections. : Community Activity Dates Participated Hours/Week Leadership Position Held? If Yes, Describe. Paid Position? Describe Participation Duties and/or Impact. Optional Addendum: If you would like to explain special circumstances that have affected the transcript (withdrawals or a drop in grades, for example), an addendum of no more than 50 words will be accepted in the Optional Addendum section below. However, even with an optional addendum, your GPA must be above a.50 to be considered eligible. Judges will deduct points for a large number of withdrawals or a drop in grades without adequate explanation. All-USA Endeavor Essay Question - Most Significant Community College Endeavor Describe your most significant endeavor since attending community college in which you applied your academic or intellectual skills from your community college education to benefit your school, community or society. The endeavor may be in community/service learning, in research, in the arts, journalism, advocacy/public affairs, etc. Judges will consider originality, initiative, degree of difficulty, results and benefit to society. Please limit your answer to ONE specific endeavor. Do not include web links or photographs in the text box as these will be removed prior to judging. Required, May Not Exceed 500 Words. Letter of Recommendation # (Leadership Assessment) Letters of recommendation give judges an expanded picture of the applicant s academic and leadership accomplishments as well as civic involvement. This letter should give a specific example of how you have demonstrated leadership abilities, service involvement, and impact outside the classroom. If you are applying to the All-USA Community College Academic Team (and related scholarships), this letter should specifically address the leadership example you discuss in your Endeavor Essay and you may find it helpful to provide a copy of your completed essay to your recommender. This letter should be from a community college faculty member, administrator, or dean, or from an employer or professional at a non-profit organization where you have volunteered. Please note that all letters should be no more than 500 words.

7 Letter of Recommendation # (Academic Assessment) The second letter of recommendation should be from a mentor or supervisor who has directly taught or mentored you while at your community college. It must be from a community college faculty member, administrator or dean and should give specific examples of how you have demonstrated academic progress and excellence, citing specific examples of in class participation or specific examples of your academic experiences with this individual as your mentor. Please note that all letters should be no more than 500 words.

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