Applications Received After Priority Deadline Will Not Be Eligible

Character Counts Scholarship Application

Priority Deadline – September 30, 2016

(applications received after priority deadline will not be eligible)

First: ______Last: ______MI ______

Mailing Address: ______

City State Zip Code

Telephone Number: ______

E-mail address: ______

Part I. Scholarship Information

ONLY COMPLETE APPLICATIONS WILL BE CONSIDERED

 Scholarship recipients will be selected on criteria listed below.

 Only current high school juniors and seniors who reside in the state of New Mexico are eligible to participate.

 Three (3) - $500 awards will be given from all completed applications received by application deadline of September 30th, 2016.

 Character Counts Scholarship funds are provided by the New Mexico Broadcasters Foundation.  Employees or immediate family members of any iHeartRadio station or New Mexico Broadcasters Foundation are not eligible to participate.

Part II. Complete the following items

1) Residence information: ( ) San Juan County, NM ( ) County, State)______

2) Current grade level: ( ) 11th ( ) 12th Name of High School:______

3) Will you be attending any post-secondary institution in 2017 (vocational or university)_____

Part III. Answer the following questions

Applicants must answer all questions below using the following format.

Format of essay: 1) Answer each question in less than 500 words. 2) Typed; Double-spaced; One-inch margins; 12 point font. 3) Permitted formats of the entry: Portable Document Format (PDF) or Microsoft Word Document. 4) Your name must be on the essay.

Submissions will be judged on: 1) Relevancy (stick to the topic). 2) Sincerity. 3) Persuasiveness using emotion of essay. Answers will be used to select award recipients. Please attach additional sheets if more space is necessary.

What are your short-term and long term educational and career goals? Describe how your educational plans will advance your career path. What extra-curricular activities have you been involved in? Any clubs, sports, music or community-service activities? Tell us how they have helped you or others and if you will continue with any of the interests.

What does “Character Counts” mean to you?

Part IV. Signature and Information Release Authorization

The above information and any attached documents are true and correct to the best of my knowledge. I give my consent to share any information above with iHeartMedia, the New Mexico Broadcasters Association and the New Mexico Broadcasters Foundation.

PRINTED NAME:______

SIGNATURE: ______DATE: ______

Mail completed applications by priority deadline of September 30, 2016 to:

iHeartMedia,

200 East Broadway,

Farmington, NM 87401

Attn: Dave Schaefer

Phone: (505) 325-1716

E-mail completed applications by priority deadline of September 30, 2016 to:

[email protected]