Chi Omega Alumnae Association of Houston Kaleidoscope Scholarship Application 2020
PLEASE READ AND COMPLETE THOROUGHLY.
• MUST BE AN INITIATED AND ACTIVE MEMBER IN GOOD STANDING IN THE SEMESTER THAT THE AWARD IS ANNOUNCED. • ALL REQUIRED DOCUMENTS (ASIDE FROM THE CHAPTER ADVISOR BOARD QUESTIONNAIRE) MUST BE SUBMITTED ELECTRONICALLY IN ONE APPLICATION PACKET ON OR BEFORE THE APPLICATION DEADLINE. MULTIPLE EMAILS OF APPLICATION INFORMATION WILL NOT BE ACCEPTED. • MUST HAVE A MINIMUM CUMULATIVE GPA OF 3.0 OR HIGHER ON A 4.0 SCALE, BE A FULL- TIME STUDENT AND HAVE COMPLETED A MINIMUM OF 30 COLLEGE CREDIT HOURS (MUST ALSO BE AN ACTIVE MEMBER FOR THE NEXT SCHOOL YEAR). • IF APPLICANT IS A CHI OMEGA LEGACY, MOTHER MUST BE A CURRENT DUES-PAYING MEMBER OF THE CHI OMEGA ALUMNAE ASSOCIATION OF HOUSTON (AS OF 1/31, THE SAME YEAR OF THE APPLICATION). • MUST HAVE ATTENDED ONE OF THE FOLLOWING LISTED HIGH SCHOOLS OR LIVE IN ONE OF THE LISTED ZIP CODES:
HIGH SCHOOL: All public high schools of Houston ISD, Alief ISD, and Spring Branch ISD; Plus, the following private schools: Houston Christian High School, Kinkaid High School, St. John’s School, Second Baptist School, St. Thomas Episcopal School, Episcopal High School, Duchesne Academy of the Sacred Heart, St. Agnes Academy, The Emery/Weiner School, AWTY International School, Lutheran North High School, Alexander- Smith Academy, St. Pius X High School, Cristo Rey College Prep of Houston, and Incarnate Word Academy.
RESIDENCE ZIP CODE: 77001-77033, 77035-77039, 77042-77057, 77060-77061, 77063, 77067, 77071-77073, 77076-77083, 77085-77088, 77091-77093, 77096-77099 77401 (City of Bellaire)
APPLICATION PACKETS ARE DUE NO LATER THAN FRIDAY, MARCH 20, 2020
1 Please type or print clearly.
PERSONAL INFORMATION
FULL NAME: ______EMAIL ADDRESS: ______
CELL PHONE: ______HIGH SCHOOL & GRADUATION YEAR: ______
HOME ADDRESS: ______
COLLEGE ADDRESS:
MOTHER’S FULL NAME (INCLUDE MAIDEN NAME): ______
MOTHER’S EMAIL ADDRESS: ______Cell #:
IS YOUR MOTHER/GRANDMOTHER A CHI OMEGA? YES NO
IF YES, PLEASE LIST UNIVERSITY, CHAPTER AND INITIATION DATE (MMYY):
______COLLEGIATE INFORMATION
UNIVERSITY NAME: ______STUDENT ID#: ______TOTAL HOURS: ______UNIVERSITY REGISTRARS’ ADDRESS: ______BILL HIGHWAY (BH) ACCOUNT#: ______EMAIL ADDRESS WITH BH ACCOUNT: ______MAJOR/MINOR: ______CUMULATIVE GPA: ______MAJOR GPA______CHAPTER MEMBER SIZE: ______0-99______100-199______200-299______300-399______400+
PLEASE LIST ALL CHI OMEGA ACTIVITIES/COMMITEES YOU HAVE SERVED ON AS AN ACTIVE MEMBER (PLEASE
INCLUDE THE NUMBER OF HOURS SPENT ON EACH CHI OMEGA ACTIVITY): ______
PLEASE LIST ALL OTHER ACTIVITIES/COMMITEES YOU HAVE SERVED ON CAMPUS OR OTHERWISE (PLEASE INCLUDE
THE NUMBER OF HOURS SPENT ON EACH ACTIVITY. Ex. STUDENT GOV’T DELEGATE 2015—10HR/WK): ______ATTACH AN ESSAY DESCRIBING YOUR CAREER PLAN: HOW HAS CHI OMEGA ENHANCED YOUR COLLEGIATE EXPERIENCE? HOW HAS CHI OMEGA PREPARED YOU FOR ATTAINING YOUR CAREER GOALS (Less than 250 words). FINANCIAL AID/FINANCIAL INFORMATION
ARE YOU CURRENTLY EMPLOYED WHILE ATTENDING SCHOOL? YES NO
IF YES, WHERE: POSITION: #HOURS/WEEK:
ARE YOU CURRENTLY EMPLOYED OVER SUMMER/SCHOOL BREAKS? YES NO IF YES, WHERE: POSITION: #HOURS/WEEK:
WHAT ARE YOUR TOTAL COLLEGE EXPENSES PER SEMESTER? ______
HOW MUCH OF THE TOTAL EXPENSES/SEMESTER ARE YOU, NOT YOUR PARENTS, PERSONALLY RESPONSIBLE?______
(APPLICANT) STUDENT - SUPPORTED PORTION OF EDUCATION TUITION/FEES $______& ______% LIVING EXPENSES $ ______& ______% BOOKS AND SUPPLIES $______& ______% SPENDING MONEY $ ______& ______% OTHER EXPENSES $______& ______% PLEASE LIST: ______
PARENT OR FAMILY - SUPPORTED PORTION OF EDUCATION TUITION/FEES $______& ______% LIVING EXPENSES $ ______& ______% BOOKS AND SUPPLIES $______& ______% SPENDING MONEY $ ______& ______% OTHER EXPENSES $______& ______% PLEASE LIST: ______
GRANTS – UNIVERSITY FINANCIAL AID, OTHER SCHOLARSHIPS AND/OR SOURCES OF EDUCATIONAL SUPPORT TUITION/FEES $______& ______% LIVING EXPENSES $ ______& ______% BOOKS AND SUPPLIES $______& ______% SPENDING MONEY $ ______& ______% OTHER EXPENSES $______& ______% PLEASE LIST: ______
REASONS FOR SCHOLARSHIP REVOCATION
• IF THE RECIPIENT TRANSFERS TO ANOTHER SCHOOL WITHIN 1 YEAR OF THE SCHOLARSHIP BEING AWARDED. (SINCE THERE IS A BREAK IN ACTIVE MEMBERSHIP FOR ONE SEMESTER BEFORE AFFILIATION) • IF THE RECIPIENT SHOULD LEAVE SCHOOL ENTIRELY FOR ANY REASON WITH IN 1 YEAR OF SCHOLARSHIP BEING AWARDED. • IF RECIPIENT’S GOOD STANDING CHANGES AT ANY TIME WITHIN 1 YEAR OF THE SCHOLARSHIP BEING AWARDED.
CHECK LIST OF ALL REQUIRED ITEMS:
COMPLETED SCHOLARSHIP APPLICATION
MOST CURRENT COLLEGE RESUME LISTING ALL ACCOLADES AND COLLEGE ACTIVITES
COPY OF CURRENT TRANSCRIPTS
SEPARATE PHOTO OF APPLICANT (WE POST PHOTOS OF ALL RECIPIENTS IN OUR ALUMNAE
NEWSLETTER)
ESSAY (NO MORE THAN 250 WORDS)
FINANCIAL AID/SCHOLARSHIP/LOANS/GRANTS INFORMATION (IF APPLICABLE)
CHAPTER ADVISORY BOARD QUESTIONNAIRE MUST BE FILLED OUT AND HAND DELIVERED TO ADVISOR. (ADVISOR TO EMAIL IT TO THE SCHOLARSHIP CHAIRPERSON)
CONSENT AND SIGNATURE
I, THE UNDERSIGNED, UNDERSTAND THE REQUIREMENTS FOR SCHOLARSHIP QUALIFICATION FOR THE CHI OMEGA ALUMNAE ASSOCIATION OF HOUSTON KALEIDOSCOPE SCHOLARSHIP. BY MY SIGNATURE BELOW, I AM GIVING MY PERMISSION TO USE MY PHOTO AND LIKENESS IN ALL CHI OMEGA EXECUTIVE HEADQUARTERS, CHI OMEGA ALUMNAE ASSOCIATION OF HOUSTON, AND CHI OMEGA KALEIDOSCOPE WEBSITES, AND PUBLICATIONS AS IT RELATES TO THESE SCHOLARSHIP OPPORTUNITIES. I ALSO CONFIRM, BY MY SIGNATURE BELOW, THAT ALL MY INFORMATION IS TRUE AND ACCURATE.
SIGNATURE OF APPLICANT DATE
SUBMIT COMPLETED APPLICATION PACKET VIA EMAIL ON, OR BEFORE, MARCH, 2020:
SCHOLARSHIP CHAIRPERSON: MELISSA CLAYBROOK DELAGARZA CHI OMEGA ALUMNAE ASSOCIATION OF HOUSTON [email protected] 713.502.7111
NO LATE OR INCOMPLETE PACKETS WILL BE ACCEPTED.
Chapter Advis0r Board Recommendation Questionnaire Form 2020 Advisors—please submit this form on or before Friday, March 20, 2020 to Melissa Claybrook DeLaGarza, Scholarship Chairperson, 713-502-7111 [email protected]
CHAPTER ADVISORY BOARD MEMBER INFORMATION
FULL NAME OF CHAPTER ADVISOR (PLEASE INCLUDE MAIDEN NAME): ______WHAT CHAPTER ADVISORY BOARD POSITION DO YOU HOLD: ______YOUR INITIATED CHAPTER NAME: ______DATE OF INITIATION: ______SIGNATURE OF ADVISOR: ______APPLICANT’S CHAPTER INFORMATION APPLICANT NAME: CHAPTER NAME: UNIVERSITY NAME: APPROXIMATE CHAPTER SIZE: 0 - 99 100 - 199 200- 299 300 - 399 400+ CHAPTER FEES/SEMESTER: HOUSING FEES/SEMESTER ( INCUDE MEAL FEES AND OTHER MISC FEES)
ACTIVE CHAPTER MEMBER INFORMATION FULL NAME OF ACTIVE CHAPTER MEMBER: PLEASE LIST THE CHAPTER EXECUTIVE OFFICES AND CARDINAL CABINET CHAIRPERSON POSITIONS THAT THIS MEMBER HAS SERVED (EX – 2015-2016):______PLEASE LIST THE CARDINAL CABINET COMMITTEE POSITIONS THAT THIS MEMBER HAS SERVED (EX. SISTERHOOD COMMITTEE-2014-2015): ______HOW IS THE MEMBER’S ATTENDANCE AND PARTICIPATION AT CHI OMEGA CHAPTER EVENTSSUCH AS RECRUITMENT WORKSHIPS, OTHER GREEK EVENTS? PLEASEEXPLAIN:______HAS THIS MEMBER ATTENDED EVERY CHAPTER MEETING? (Y/N) IF SHE HAS MISSED ANY MEETINGS, PLEASE LET US KNOW HOW MANY SHE HAS MISSED IN A YEAR: 1-2 3-4 5+. ______ARE THERE ANY SPECIAL CIRCUMSTANCES THAT OCCURRED FOR THE MEMBER TO NOT REGULARLY ATTEND CHAPTER MEETINGS? IF SO, PLEASE EXPLAIN: ______HOW DOES THIS MEMBER SPECIFICALLY UPHOLD OUR PILLARS AND SYMPHONY TO NOT ONLY HER FELLOW ACTIVE MEMBERS BUT ALSO THE UNIVERSITY AT LARGE? ______ANY SPECIAL CIRCUMSTANCES ABOUT THIS MEMBER THAT YOU FEEL WE WOULD NEED TO KNOW? IF SO, PLEASE LIST AND EXPLAIN: ______HOW DOES THIS MEMBER SPECIFICALLY UPHOLD OUR PILLARS AND SYMPHONY TO NOT ONLY HER FELLOW ACTIVE MEMBERS BUT ALSO THE UNIVERSITY AT LARGE? ______ANY SPECIAL CIRCUMSTANCES ABOUT THIS MEMBER THAT YOU FEEL WE WOULD NEED TO KNOW? IF SO, PLEASE LIST AND EXPLAIN: ______