Gene A. White Memorial Scholarship Application - Kendall County

Gene A. White Memorial Scholarship ApplicationELIGIBILITYApplicants must be an honorably discharged veteran, the widow of a veteran, or the direct dependent of aveteran who resides in Kendall County, Illinois. For the purposes of this application, a direct dependent isa biologically related, child or grandchild. Dependent applicants may be direct dependents of veteranswho are listed as missing-in-action, listed as a prisoner-of-war, or were killed-in-action. IMPORTANT: Allapplicants MUST provide discharge documentation with the application.COMMITTEE STATEMENTThe selection process will be accomplished by first establishing anonymity for the applicant. The reviewof all applications by the committee will be based on academic achievement, ability, extracurricularactivities, and without regard to the person. This scholarship can be awarded to an eligible recipient whois or will be attending school as a full or part time student.PRIVACY ACT STATEMENTThe purpose of this information is intended for identification purposes only and shall not be made public.All other information provided in this application shall be used to assess scholastic achievement andoverall evaluation for the award. Completion of this form is mandatory. Failure to provide the requiredinformation may result in delay, improper processing, or disqualification. COMPLETED APPLICATIONS MUST BE RECEIVED PRIOR TO THE MARCH 1, 2015 DEADLINE. COMPLETED APPLICATIONS MAY BE RETURNED BY MAIL, FAX, OR IN PERSON TO:Veterans Assistance Commission of Kendall County811 West John Street – Suite 264Yorkville, IL. 60560-9249Fax: 630-553-0003ANNOUNCEMENT OF THE AWARD WILL BE MADE AT THE VACKC JUNE MEETING.1

APPLICATION NUMBER _______________SCHOLARSHIP APPLICATION[This cover sheet and all of the pages of the application will be assigned a number and this coversheet will be removed before the application is sent to the Selection Committee]APPLICANT INFORMATIONApplicant Name: ____________________________________________________________________________________________Home Street Address: ______________________________________________________________________________________City, State, and Zip Code:___________________________________________________________________________________School Address: ___________________________________________________________________________________________________________________________________________________________________________________________________________Home Phone: [ ] ______-__________ Cell Phone: [ ] ______-__________ School Phone: [ ] ______-__________EDUCATIONAL INFORMATIONName, complete address, and phone number of high school(s) attending or graduated from:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Name, complete address, and business office phone number of any college(s) attended:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________AN ACKNOWLEGMENT RECEIPT FOR THE APPLICATION SHALL BE SENT BY THE VACKC.2

APPLICATION NUMBER _______________PRIVACY ACT STATEMENTThe applicant has signed this release of information for this privacy act statement. Thepurpose of this request is to obtain information about the academic performance of theapplicant. It will be used by the VACKC Scholarship Committee to evaluate the applicant’sacademic achievement for the award of the Gene A. White Memorial Scholarship.This applicant has authorized the release of all transcript data by your facility. This datashall be returned in a timely manner to the VACKC Scholarship Committee at the addressor fax number provided below. Failure to do so may result in delay, improper processing,or disqualification of the applicant.I give my permission for the following named high school(s) / college(s) to release myofficial transcript.High School:_________________________________________________________________________________High School:_________________________________________________________________________________College:_______________________________________________________________________________________College:_________________________________________________________________________________________________________________________________________________________________ ____________________________________Signature of ApplicantDateRETURN THE COMPLETED APPLICATION BEFORE MARCH 1, 2015 TO:Veterans Assistance Commission of Kendall County811 West John Street – Suite 264Yorkville, IL. 60560-9249Fax: 630-553-00033

APPLICATION NUMBER _____________HIGH SCHOOL AND COLLEGE TRANSCRIPT REQUESTINSTRUCTIONSHigh school/college officials are requested to complete this form. Attach a copy of the student’s officialtranscript, including grades achieved and return to student to submit with application.SCHOOL DATAName of School: ____________________________________________________________________________________________School Address: ___________________________________________________________________________________________________________________________________________________________________________________________________________Name of Academic Advisor: _______________________________________________________________________________Title: _________________________________________________________________________________________________________How long have you known this applicant? _______________________________________________________________How often and in what situation have you been in contact with the applicant? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________EVALUATION OF PERSONAL TRAITSGrade applicant in each category using the following values:Poor (1) Below Average (2) Average (3) Above Average (4) Superior (5)Cooperation ________ Courtesy ________Dependability ________ Industriousness ________Initiative ________ Leadership ________Maturity ________ Self Control ________Personal Appearance ________ Resourcefulness ________Using the same point scale above, what is the ability of the applicant to select a goal and achieve it? _______4

APPLICATION NUMBER _____________School official’s comments and additional observations about the applicant (Please type and use extrapages if needed): _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________5

Signature: _________________________________________________________ Date: __________________________________6

APPLICATION NUMBER ____________STUDENT DATAStudent’s dates of attendance:From: _________________________ To: _________________________ Graduation Date: _________________________(Check One ) High School __________ College __________Cumulative Grade Point Average (high school/college where applicable) ____________________________College entrance test scores:CEEB _______________ SAT _______________ ACT _______________CEEB/SAT Verbal _______________ CEEB/SAT Math _______________ Test Date _______________ACT Composite _______________High school class size _______________Test Date _______________High school class ranking _______________Name and complete address of colleges to which applied:Accepted? (Y/N)1.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________7

APPLICATION NUMBER _____________What influenced your choice(s)? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________WORK EXPERIENCE(Furnish a three year employment history. Use extra sheets of paper if necessary)[1] Employer:__________________________________________________ Employment dates:_______________________Job description:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________[2] Employer:__________________________________________________ Employment dates:_______________________Job description:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________[3] Employer:__________________________________________________ Employment dates:_______________________Job description:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________8

APPLICATION NUMBER __________ADDITIONAL INFORMATIONUse separate sheets for each of the following.1. In a typed essay explain in 250 words or less how you plan to utilize your education. Includeprofessional goals and career plans. Please refrain from the use of names.2. Provide any additional information that may be pertinent to your application. Again, pleaserefrain from the use of names.3. List and define extracurricular school and community activities and awards.9