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The Lambda Chapter of Kappa Alpha Psi Fraternity Inc. John Milton Lee 2015 Scholarship Application Applicant Name: ________________________________________________ To the applicant: Type or print neatly in black or blue ink. Attach your one (1) page typed essay detailing why you should be considered to receive scholarship award.
APPLICANT INFORMATION Name of Applicant: ______________________________________________________________ Last four digits of Social Security Number: _______________ (to be used for application tracking only) Date of Birth:________/______________/___________ Address: (Use home mailing address) Street__________________________________________________________________ City: _________________________________ State: _________________________________ Zip: _________________________________ Home Phone: _________________________________ E-Mail Address: _________________________________
Parents Information Name: ____________________________Work/Home Phone: _________________________________ E-Mail Address: _______________________________________________________________ Name: __________________________Work/Home Phone: ___________________________________ E-Mail Address: _______________________________________________________________
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The Lambda Chapter of Kappa Alpha Psi Fraternity Inc. John Milton Lee 2015 Scholarship Application Applicant Name: ________________________________________________ HIGH SCHOOL INFORMATION Are you currently a high school senior? ________ If yes, anticipated date of high school graduation: ________
HIGH SCHOOL NAME: __________________________________________________________ Address:
__________________________________________________________
__________________________________________________________ Phone Number: __________________________________________________________ Cumulative GPA: ________________________ Class Rank: ________________________ Name of School Counselor: ___________________________________________ List academic honors or other achievements received in high school.
List leadership activities and positions involved in while in high school.
List extracurricular activities and community involvement. (please include # of community service hours)
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The Lambda Chapter of Kappa Alpha Psi Fraternity Inc. John Milton Lee 2015 Scholarship Application Applicant Name: ________________________________________________ COLLEGE/UNIVERSITY/TECHNICAL SCHOOL INFORMATION Please list name and address of the college you plan to attend in the Fall of 2015.
University Name: ________________________ Major: ________________________ Degree Seeking (e.g. AS, BA): ________________________
WORK EXPERIENCE
Please describe your work experience during the past four years (e.g., babysitting, food server, lawn service, office work). Indicate dates of employment from each job and the approximate number of hours worked each week. List amounts earned at each job.
Employer/ Position
From – Mo/Yr To – Mo/Yr. Hours per week Amount Earned
In the event you are selected, list the school address where your scholarship check would be mailed: Address: Street: ________________________________________________________ City: ____________________________ State: _____________ Zip: _____________
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The Lambda Chapter of Kappa Alpha Psi Fraternity Inc. John Milton Lee 2015 Scholarship Application Applicant Name: ________________________________________________ High School Certification Form To the applicant: Please complete part I and give this form to your high school counselor to complete Part II. Counselor should complete in accordance with the instruction given below.
Part I Name of Student: ________________________ ______________________________ (Printed) (Signature) To The Counselor: Please complete Part II of this form Please attach an official copy of this student’s transcript with grades through most recent semester. Please sign this form Please return form and transcript to student sealed. Part II High School ______________________________________________ Address __________________________________________________ __________________________________________________ Date of Anticipated Graduation: ________________________________ SAT or ACT Scores: SAT Scores (Verbal & Math Totals) ACT Scores (Composite) _______ _______ ________ ________ _______ _______ ________ _________ Class Rank: This student is ranked number__________out of graduating class of ______students. GPA: Please report as 3.0, 3.5 etc. _____ on a ________ 4.0, 5.0, 6.0 scale. Name of Counselor: ____________________________ ___________________________ (Printed) (Signature) Email: ___________________________________ Date:________
Phone: (____)_________________
ALL INFORMATION AND ANY QUESTIONS SHOULD BE DIRECTED TO: APPLICATION MATERIALS MUST BE RECEIVED NO LATER THAN
June 10th, 2015
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The Lambda Chapter of Kappa Alpha Psi Fraternity Inc. John Milton Lee 2015 Scholarship Application Applicant Name: ________________________________________________
High School Certification Form To the applicant: Please complete part I and give this form to one of your high school teachers to complete Part II. Your teacher should complete in accordance with the instruction given below. Part I Name of Student: ________________________ ______________________________ (Printed) (Signature) To The Counselor: Please complete Part II of this form. Please write a letter of recommendation for this student. Please sign this form. Please return form and transcript to student sealed. Part II Academic Ratings
Good
Excellent
Character & Personality Rat- Good ings:
Excellent
Outstanding
Academic Motivation Creativity Academic Self-Discipline Academic Growth Potential
Self-Confidence
One of the top few ever encountered
Outstanding One of the top few ever encountered
Warmth of Personality Sense of Humor Concern for others Energy Emotional Maturity Personal Initiative Reaction to setbacks Integrity Respect Accorded by Faculty Extracurricular Involvement Name of Teacher: ____________________________ ___________________________ (Printed) (Signature)
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Email: ___________________________________
Date:__________
Phone: (____)_________________
Leadership
The Lambda Chapter of Kappa Alpha Psi Fraternity Inc. John Milton Lee 2015 Scholarship Application Applicant Name: ________________________________________________ Submit an essay describing why you should be selected to receive Scholarship funds. The essay should be no more than two pages.
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The Lambda Chapter of Kappa Alpha Psi Fraternity Inc. John Milton Lee 2015 Scholarship Application Applicant Name: ________________________________________________
It is understood and agreed that any misrepresentation by me in this application or the attached essay will be sufficient cause for cancellation and/or separation from the program. Also, I voluntarily give the company permission to make a thorough investigation of my past accomplishments and all other facts as stated on the reference form. I release from liability or responsibility all persons, places of business, municipalities and schools supplying such information:
Applicant’s Signature: _________________________ Date: ________________ Parent or Guardian Signature: ________________________ Date: ________________
ALL INFORMATION AND ANY QUESTIONS SHOULD BE DIRECTED TO: APPLICATION MATERIALS MUST BE RECEIVED NO LATER THAN
June 10th, 2015
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The Lambda Chapter of Kappa Alpha Psi Fraternity Inc. John Milton Lee 2015 Scholarship Application Applicant Name: ________________________________________________
Application Checklist: ________ ________ ________ ________
Scholarship Application Counselor Certification Form 2 Teacher Recommendations Scholarship Essay Response
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