BEXAR COUNTY SCHOLARSHIP CLEARING HOUSE An Activity of MINNIE STEVENS PIPER FOUNDATION 1250 NE Loop 410, Suite 810 San Antonio, Texas 78209-1539 Phone:(210) 525-8494 Fax:(210) 341-6627 Email:[email protected]
STUDENT APPLICATION FOR: SAZA COMMISSION, INC. – LENARD C. BROOKS MEMORIAL SCHOLARSHIP– 2017-2018 DEADLINE: 4:00 P.M. DECEMBER 14, 2017 This application is specific to SAZA Commission Scholarship ONLY.
The Bexar County Scholarship Clearing House (BCSCH) serves as a liaison between applicants and local scholarship donors who wish to assist high school students in furthering their educational goals. The BCSCH aids the sponsoring organization in their screening and selection process. The deadline is 4:00 p.m. Thursday, December 14, 2017.
Submitting a scholarship application does not guarantee a scholarship. Therefore, you are encouraged to apply for all financial aid opportunities available to you through other sources, including the financial aid office at the college or university of your choice.
Completing your application with attention to every detail plays an important part in your chances of being selected as a scholarship recipient. Please note the following helpful hints:
● Remember deadlines: being responsible for meeting deadlines shows you are ready for college. There will be no exceptions to the deadline noted above. ● Do not leave any blanks: for example, do not skip the financial information section, or forget to have your parent sign in the Acknowledgement section (both student and parent must sign) ● Don’t be shy about your school and community activities. Attached résumés are accepted. ● The Letter of Recommendation needs to be from an adult who is not a relative. It should reference your character in regard to truthfulness, conscientiousness, and the ability to accept responsibility. ● Personal Narratives should be limited to 200-400 words, typed, or hand printed in ink. Use spell-check and edit your final paper. Print your name at the top and sign your name at the bottom. Narrative topics to consider: - Describe your future plans, hopes and ambitions, and how/why you arrived at that decision; or - Describe how a specific person, personal situation, event, or activity has impacted your life. ● Transcripts and Exam scores – your transcript, SAT and/or ACT scores are required with all applications.
NOTE: If you are chosen as an award recipient of any scholarship program, the sponsoring organization will contact you directly. BCSCH is not responsible for notifying scholarship winners.
To ensure accurate and timely processing of information please submit ALL documents as an individual packet secured with a paperclip (no staples, please). DO NOT copy as a 2-sided document, write on the back or submit inside a folder. Students may include a personal résumé highlighting activities, but it is not a requirement. A complete application packet will consist of the following:
CHECKLIST: ____Application (pages 1-3) ____Transcript of completed courses ____Transcript of pending senior year courses ____Test Scores: ACT or SAT (may be included on transcript) ____Evaluation from Counselor ____Evaluation from English Teacher ____Evaluation from Other Teacher ____Personal Narrative (200-400 words, typed or hand printed) ____Adult Recommendation (adult, non-relative) ____Advanced Placement (AP) exam scores, if available ____Signatures of both student and parent or legal guardian (on page 3) ____Student Name printed on all pages submitted with application ____Additional essays, recommendations or documents as requested by scholarship organization (if applicable)
3/2017 BEXAR COUNTY SCHOLARSHIP CLEARING HOUSE An Activity of MINNIE STEVENS PIPER FOUNDATION 1250 NE Loop 410, Suite 810 San Antonio, Texas 78209-1539 Phone:(210) 525-8494 Fax:(210) 341-6627 Email:[email protected]
2017 APPLICATION FOR SAZA COMMISSION, INC.- LENARD C. BROOKS MEMORIAL SCHOLARSHIP
S T U D E N T I N F O R M A T I O N
Mr.___/Miss ______Last 4 digits of SSN # ______First Middle Last
Address ______Number & Street City State Zip Code Primary Phone:______Alternate Phone:______Email: ______
High School you now attend: ______Middle School attended:______
Age ____ Date of Birth ______Are you a U.S. Citizen? ____ or Permanent Resident? ____
P A R E N T I N F O R M A T I O N
Father's Name: ______Age _____ email: ______Home Address ______Home # ______Number & Street City State Zip Code Work # ______Father’s Employer:______Company Name City/State Job Title
Mother's Name: ______Age _____ email: ______Home address ______Home # ______Number & Street City State Zip Code Work # ______Mother’s Employer:______Company Name City/State Job Title
IF APPLICABLE, step-parent’s name and employer ______
Parents are: Married ______Divorced ______Separated ______Remarried ______Widowed _____ If parent(s) is(are) deceased, please check: Father ______Mother ______
Number of immediate family members residing in your home (INCLUDE parents and yourself):_____ List ages of all family members currently residing in your home: ______
F I N A N C I A L I N F O R M A T I O N:
2017 Annual gross income of family: 1. Under $10,000 ______6. $50,000- 59,999 ______Amount indicated should include the 2. $10,000-19,999 ______7. 60,000- 74,999 ______2017 estimated income for yourself 3. 20,000-29,999 ______8. 75,000- 89,999 ______and parent(s) with whom you reside 4. 30,000-39,999 ______9. 90,000-119,999 ______5. 40,000-49,000 ______10. 120,000- and up ______
3/2017 - 1 - Who will be responsible for financing your college education? ______Will you be receiving Veterans Educational Benefits for college? ______NOTE: SOME SCHOLARSHIP DONORS MAY REQUEST VERIFICATION OF INCOME TO ESTABLISH FINANCIAL NEED.
3/2017 - 2 - SAZA COMMISSION-LEONARD C. BROOKS MEMORIAL SCHOLARSHIP Student Name:
FINANCIAL INFORMATION (cont’d)
Do you have a savings account for college expenses? _____ If so, indicate amount $______Indicate the number of family members in your household who will be in college (or vocational/ technical school) at least half-time next year (2018-2019). INCLUDE YOURSELF! ______Medical/Dental expenses for 2018 not covered by insurance ______Describe Other Unusual Expenses:
Any comments/additional information (if there are unusual circumstances in your family which may be pertinent to applying for scholarships, please briefly explain here):
S C H O O L P R E F E R E N C E / I N T E N D E D M A J O R
College or university you wish to attend:
1st choice ______Name City State
2nd choice ______Name City State
Write in your intended college major and enter the associated code number as found on page 4 (if your major is not included, just write it in below).
Intended Major(s): ______Code #(s)______Intended Career:______Explain any educational plans you may have beyond four years of college:
S C H O O L & C O M M U N I T Y A C T I V I T I E S (Include a personal résumé or additional pages as needed, but please do not write on back) # of Activities Years Note your role, offices held, awards received
3/2017 - 3 - SAZA COMMISSION-LEONARD C. BROOKS MEMORIAL SCHOLARSHIP Student Name:
E M P L O Y M E N T R E C O R D
Present Employer: ______Dates worked: From ______To ______
Job Title/Duties:______Hours worked per week:______
Past Employer: ______Dates worked: From ______To ______
Job Title/Duties:______Hours worked per week:______
E T H N I C I T Y / H E R I T A G E
This information is optional; however, it may be required to establish eligibility for certain scholarships that are based on ethnic or national origins.
Which of the following categories best describes you? (choose one or more)
______1-American Indian or Alaskan native ______6-Italian American ______2-Asian American or Pacific Islander ______7-Puerto Rican ______3-Black or African American ______8-Hungarian ______4-White or Caucasian ______9-Other (specify______) ______5-Hispanic
S T U D E N T / P A R E N T A C K N O W L E D G E M E N T
We understand that this is only a Scholarship Application and that neither Minnie Stevens Piper Foundation nor the Bexar County Scholarship Clearing House makes any representations or assurances regarding the award or availability of scholarships.
We authorize and request the Bexar County Scholarship Clearing House to release the information contained herein, parents' financial statements, and all other information contained in student’s Application Packet, to possible donors and/or colleges and universities upon request of such donors and/or colleges and universities.
A FALSE STATEMENT, ALTERATION OR OMISSION OF PERTINENT INFORMATION FROM THIS APPLICATION WILL BE CONSIDERED JUST CAUSE FOR REMOVAL OF APPLICATION FROM SCHOLARSHIP CONSIDERATION.
______Student (signature required) Date Parent (signature required) Date
3/2017 - 4 - CODES FOR PROGRAMS OF STUDY
99-UNDECIDED 180-FINE ARTS, general 265 Earth Sciences 181 Art (draw/paint/sculpt) 266 Geography 100-AGRICULTURE, general 182 Art History 267 Geology 101 Animal Science 183 Dance 268 Oceanography 102 Forestry 184 Dramatic Arts 269 Physics 103 Horticulture 185 Music (compose/perform/theory) 270 Zoology 104 Wildlife Management 186 Music History 271 Meteorology 187 Oratory (speech/debate) 110-ARCHITECTURE, general 280-NUTRITION, general 111 Landscape 190-HOME ECONOMICS, general 281 Dietetics 191 Fashion Design 120-BUSINESS, general 192 Fashion Merchandising 290-PHILOSOPHY, general 121 Accounting 193 Interior Design 291 Religion 122 Banking 123 Economics 200-LANGUAGES, general 300-PRE-PROFESSIONAL PROGRAMS 124 Finance 201 French 301 Pre-Dentistry 125 Insurance 202 German 302 Pre-Law 126 Management 203 Greek 303 Pre-Medicine 127 Marketing 204 Italian 304 Pre-Veterinary Medicine 128 Human Resources 205 Latin 206 Spanish 310-SOCIAL SCIENCES, general 130-COMMUNICATIONS, general 311 Anthropology 131 Advertising 210-LAW ENFORCEMENT, general 312 Archaeology 132 Journalism 211 Criminal Justice 313 History 133 Photography 314 International Relations 134 Public Relations 220-MATHEMATICS, general 315 Political Science 135 Radio-TV-Film 316 Psychology 230-MEDICAL FIELDS, general 317 Social Work 140-COMPUTER SCIENCE,general 231 Chiropractic 318 Sociology 141 Programming 232 Dental Assisting 142 System Analysis 233 Dental Hygiene 320-TRADE/VOCATIONAL FIELDS 234 Emergency Medical Tech 321 Aeronautical/Aviation 150-EDUCATION, general 235 Medical Assistant 322 Air Cond./Heating Tech 151 Elementary Education 236 Medical Technician 323 Airline/Travel careers 152 Secondary Education 237 Nursing, general 324 Auto Mechanics 153 Health Education 238 Occupational Therapy 325 Business Technology 154 Physical Education 239 Optometry 326 Carpentry/Construction 155 Special Education 240 Pharmacy 327 Cosmetology 241 Physical Therapy 328 Culinary Arts 160-ENGINEERING, general 242 Physician Assistant 329 Drafting 161 Aerospace 243 Public Health 330 Electronics 162 Chemical 244 Radiology 331 Graphic Arts 163 Civil 245 Sports Medicine 332 Hotel/Food Service Mgmt 164 Electrical/Electronics 246 Surgical Technology 333 Industrial Arts 165 Industrial 247 Respiratory Therapy 334 Machine-Working 166 Mechanical 248 Speech Therapy 335 Masonry 167 Nuclear 336 Metal-Working 168 Petroleum 250-MORTUARY SCIENCE, general 337 Plumbing 338 Real Estate 170-ENGLISH, general 260-NATURAL SCIENCES, general 339 Secretarial 171 Classics 261 Astronomy 340 Welding 172 Creative Writing 262 Biology 173 Linguistics 263 Botany 174 Literature 264 Chemistry
3/2017 - 5 - TEACHER/COUNSELOR EVALUATION FORM
SAZA COMMISSION-LEONARD C. BROOKS MEMORIAL SCHOLARSHIP
This form is considered your personal endorsement of a student, highlighting his/her qualifications pertinent to their success in college. In addition to the ratings below, scholarship committee assessment is also based your additional comments. All students are unique, therefore we ask for individualized comments (no one-stop, cut/paste answers). Any particularly outstanding qualities of the student should be noted, such as character, altruistic endeavors, leadership skills, etc.
Student's Name ______High School ______First Middle Last
- Rate the following characteristics of the student with a check mark below: -
GOOD VERY GOOD EXCELLENT UNKNOWN 1. Motivation
2. Responsibility
3. Integrity, honesty
4. Diligence, perseverance
5. Cooperation
6. Leadership
7. Emotional stability
8. Common sense, judgment
9. Appearance, neatness, poise
Additional Comments ______
______
______
______
______
______
______
Evaluator:______Title/Department:______(print first and last name)
Signature: ______Email: ______
**PLEASE SUBMIT THIS FORM WITH THE STUDENT’S APPLICATION PACKET – DO NOT MAIL SEPARATELY**
03/2017 TEACHER/COUNSELOR EVALUATION FORM
SAZA COMMISSION-LEONARD C. BROOKS MEMORIAL SCHOLARSHIP
This form is considered your personal endorsement of a student, highlighting his/her qualifications pertinent to their success in college. In addition to the ratings below, scholarship committee assessment is also based your additional comments. All students are unique, therefore we ask for individualized comments (no one-stop, cut/paste answers). Any particularly outstanding qualities of the student should be noted, such as character, altruistic endeavors, leadership skills, etc.
Student's Name ______High School ______First Middle Last
- Rate the following characteristics of the student with a check mark below: -
GOOD VERY GOOD EXCELLENT UNKNOWN 1. Motivation
2. Responsibility
3. Integrity, honesty
4. Diligence, perseverance
5. Cooperation
6. Leadership
7. Emotional stability
8. Common sense, judgment
9. Appearance, neatness, poise
Additional Comments ______
______
______
______
______
______
______
Evaluator:______Title/Department:______(print first and last name)
Signature: ______Email: ______
03/2017 **PLEASE SUBMIT THIS FORM WITH THE STUDENT’S APPLICATION PACKET – DO NOT MAIL SEPARATELY**
TEACHER/COUNSELOR EVALUATION
SAZA COMMISSION-LEONARD C. BROOKS MEMORIAL SCHOLARSHIP
This form is considered your personal endorsement of a student, highlighting his/her qualifications pertinent to their success in college. In addition to the ratings below, scholarship committee assessment is also based your additional comments. All students are unique, therefore we ask for individualized comments (no one-stop, cut/paste answers). Any particularly outstanding qualities of the student should be noted, such as character, altruistic endeavors, leadership skills, etc.
Student's Name ______High School ______First Middle Last
- Rate the following characteristics of the student with a check mark below: -
GOOD VERY GOOD EXCELLENT UNKNOWN 1. Motivation
2. Responsibility
3. Integrity, honesty
4. Diligence, perseverance
5. Cooperation
6. Leadership
7. Emotional stability
8. Common sense, judgment
9. Appearance, neatness, poise
Additional Comments ______
______
______
______
______
______
______
Evaluator:______Title/Department:______(print first and last name)
Signature: ______Email: ______
03/2017 **PLEASE SUBMIT THIS FORM WITH THE STUDENT’S APPLICATION PACKET – DO NOT MAIL SEPARATELY**
03/2017