<p>CHARLES H. WESLEY PRESIDENTIAL SCHOLARSHIP 2012-2013 APPLICATION </p><p>SECTION 1 – PERSONAL INFORMATION </p><p>LAST NAME: FIRST NAME:</p><p>ID NUMBER:</p><p>HOME ADDRESS (PLEASE INCLUDE CITY, STATE, AND ZIP CODE)</p><p>HOME PHONE: CELL PHONE:</p><p>EMAIL ADDRESS:</p><p>SECTION 2 – ACADEMIC INFORMATION </p><p>INTENDED MAJOR: INTENDED MINOR:</p><p>SECTION 3 –ACTIVITIES AND INTERESTS </p><p>A. LIST AND BRIEFLY DESCRIBE CURRENT EXTRACURRICULAR ACTIVITIES (STUDENT COUNCIL, SPORTS, ETC.) AND VOLUNTEER EXPERIENCES(HABITAT FOR HUMANITY)</p><p>ORGANIZATION POSITION HELD (IF ANY) DATE OF INVOLVEMENT</p><p>SECTION 4 – ESSAY </p><p>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. </p><p>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. </p><p>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. </p><p>APPLICANT’S NAME:</p><p>HOW LONG HAVE YOU KNOWN THE APPLICANT?:</p><p>IN WHAT CAPACITY HAVE YOU KNOWN THE APPLICANT?:</p><p>A. EVALUATE THE APPLICANT IN TERMS OF THE FOLLOWING CHARACTERISTICS BY MAKING A CHECK UNDER THE APPROPRIATE HEADING.</p><p>ABOVE BELOW NO BASIS FOR OUTSTANDING AVERAGE AVERAGE AVERAGE JUDGMENT A. LEADERSHIP </p><p>B. CHARACTER</p><p>C. ACADEMIC PROMISE</p><p>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.</p><p>PRINT NAME: ______SIGNATURE______</p><p>JOB TITLE: ______PHONE: ______</p><p>E-MAIL ______DATE: ______</p><p>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. </p><p>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. </p><p>APPLICANT’S NAME:</p><p>HOW LONG HAVE YOUR KNOWN THE APPLICANT?:</p><p>IN WHAT CAPACITY HAVE YOU KNOWN THE APPLICANT?:</p><p>A. EVALUATE THE APPLICANT IN TERMS OF THE FOLLOWING CHARACTERISTICS BY MAKING A CHECK UNDER THE APPROPRIATE HEADING.</p><p>ABOVE BELOW NO BASIS FOR OUTSTANDING AVERAGE AVERAGE AVERAGE JUDGMENT A. LEADERSHIP </p><p>B. CHARACTER</p><p>C. COMMITMENT TO COMMUNITY SERVICE/IMPROVEMENT</p><p>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.</p><p>PRINT NAME: ______SIGNATURE______</p><p>JOB TITLE: ______PHONE: ______</p><p>E-MAIL ______DATE: ______</p>