Charles H. Wesley Presidential Scholarship

CHARLES H. WESLEY PRESIDENTIAL SCHOLARSHIP 2012-2013 APPLICATION

SECTION 1 – PERSONAL INFORMATION

LAST NAME: FIRST NAME:

ID NUMBER:

HOME ADDRESS (PLEASE INCLUDE CITY, STATE, AND ZIP CODE)

HOME PHONE: CELL PHONE:

EMAIL ADDRESS:

SECTION 2 – ACADEMIC INFORMATION

INTENDED MAJOR: INTENDED MINOR:

SECTION 3 –ACTIVITIES AND INTERESTS

A. LIST AND BRIEFLY DESCRIBE CURRENT EXTRACURRICULAR ACTIVITIES (STUDENT COUNCIL, SPORTS, ETC.) AND VOLUNTEER EXPERIENCES(HABITAT FOR HUMANITY)

ORGANIZATION POSITION HELD (IF ANY) DATE OF INVOLVEMENT

SECTION 4 – ESSAY

IN APPROXIMATELY 500 WORDS, EXPLAIN HOW THE MAJOR THAT YOU HAVE CHOSEN WILL ALLOW YOU AS A LEADER TO RESPOND TO A SPECIFIC SOCIAL PROBLEM. PLEASE ATTACH YOUR TYPED ESSAY TO THE APPLICATION. HAND-WRITTEN ESSAYS WILL NOT BE ACCEPTED.

PLEASE PROVIDE THIS FORM TO THE STUDENT IN A SEALED ENVELOPE WITH YOUR SIGNATURE ON THE SEALED FLAP. THANK YOU FOR TAKING THE TIME TO COMPLETE THIS FORM ON THE BEHALF OF THE APPLICANT.

SECTION 5 –TEACHER/COUNSELOR/PRINCIPAL/COACH/SCHOOL ADMINISTRATOR RECOMMENDATION TO APPLICANT: PLEASE PROVIDE THIS FORM TO A HIGH SCHOOL TEACHER. PLEASE INCLUDE THE RECOMMENDATION WITH YOUR APPLICATION PACKET.

APPLICANT’S NAME:

HOW LONG HAVE YOU KNOWN THE APPLICANT?:

IN WHAT CAPACITY HAVE YOU KNOWN THE APPLICANT?:

A. EVALUATE THE APPLICANT IN TERMS OF THE FOLLOWING CHARACTERISTICS BY MAKING A CHECK UNDER THE APPROPRIATE HEADING.

ABOVE BELOW NO BASIS FOR OUTSTANDING AVERAGE AVERAGE AVERAGE JUDGMENT A. LEADERSHIP

B. CHARACTER

C. ACADEMIC PROMISE

B. PLEASE PROVIDE ADDITIONAL COMMENTS THAT SPEAK TO THE APPLICANT BEING DESERVING OF THIS AWARD. YOU MAY PROVIDE ADDITIONAL SUPPORT OF THE STUDENT’S NOMINATION BY ATTACHING A SUPPLEMENTAL LETTER AS WELL.

PRINT NAME: ______SIGNATURE______

JOB TITLE: ______PHONE: ______

E-MAIL ______DATE: ______

P LEASE PROVIDE THIS FORM TO THE STUDENT IN A SEALED ENVELOPE WITH YOUR SIGNATURE ON THE SEALED FLAP. THANK YOU FOR TAKING THE TIME TO COMPLETE THIS FORM ON THE BEHALF OF THE APPLICANT.

SECTION 5 COMMUNITY LEADER/VOLUNTEER COORDINATOR/WORK SUPERVISOR RECOMMENDATION TO APPLICANT: PLEASE PROVIDE THIS FORM TO A COUNSELOR OR ADMINISTRATOR. PLEASE INCLUDE THE RECOMMENDATION WITH YOUR APPLICATION PACKET.