Anne Morand Memorial Scholarship Fund 2016 Application Form

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1 PERSONAL INFORMATION First Name Are you a U.S. citizen? Yes No Middle Name Last Name Gender: Male Female Home Address City County Home Phone Cell Phone State Zip Code Primary Address Secondary Address Date of Birth How did you learn about the? EXTRACURRICULAR ACTIVITIES Please indicate if you are being considered for: [ ] Valedictorian [ ] Salutatorian [ ] Eagle Scout [ ] National Honor Society List any academic honors you have received in high school. 1

2 If you have participated in academic activities outside of your high school, please list the name of the program, sponsoring institution, participation dates and certification, credits awarded (if applicable.) Activity 1 Activity Name Description Sponsoring Institution Position(s) Held Begin Activity / End Activity / Credit Earned Activity 2 Activity Name Description Sponsoring Institution Position(s) Held Begin Activity / End Activity / Credit Earned Activity 3 Activity Name Description Sponsoring Institution Position(s) Held Begin Activity / End Activity / Credit Earned Activity 4 Activity Name Description Sponsoring Institution Position(s) Held Begin Activity / End Activity / Credit Earned Have you ever traveled outside your state? If yes, where and when? 2

3 Have you ever traveled internationally? If yes, where and when? TRANSCRIPT INFORMATION Applicant's Current School Name of High School High School Address High School Website City State Zip Code Guidance Counselor's Name Guidance Counselor's Have you completed any college credits? What is the number of students enrolled in your high school? What is the size of your graduating class? GPA (on a absolute scale of 4.0) Class Rank School Year (Grade 12) High School Name Grade 12 Cumulative GPA Courses and Grades 3

4 School Year (Grade 11) High School Name Grade 11 Cumulative GPA Courses and Grades School Year (Grade 10) High School Name Grade 10 Cumulative GPA 4

5 Courses and Grades School Year (Grade 9) High School Name Grade 9 Cumulative GPA Courses and Grades 5

6 SCHOLASTIC INFORMATION Test Information SAT SCORES: Critical Reading Math Writing Total Score Test Date Test Date Test Date Total Score without Writing ACT SCORE: Composite ACT Score Test Date College Information Please list the colleges to which you have applied or will apply in order of choice. First Choice Location of College Second Choice Location of College Third Choice Location of College What is your intended major(s)? What are your intended minor(s)? Are you a first generation college student? (If either parent/guardian attended a two- or fouryear college, answer "No") 6

7 FINANCIAL INFORMATION Gross Annual Family Income How many people currently reside in your home, including you? How many siblings are 23 years of age or younger? Number of siblings currently attending college Is this a single or dual parent household? Were you employed while in high school? If yes, list job names (include summers). Have you applied for/will apply for any scholarships or mentoring programs from any organization other than those offered by your college or university? Please list here. #1 #2 Federal Student Aid, a part of the U.S. Department of Education, is the largest provider of student financial aid in the nation. If you have already filed your Free Application for Federal Student Aid (FAFSA), please indicate that here. HOUSEHOLD INFORMATION Primary Residence of Applicant Home Address City State Zip Code County 7

8 Parent 1/Guardian Household Information First Name Middle Initial Last Name Relationship to Applicant Is Parent/Guardian a U.S. citizen? Home Phone Number Cell Phone Number Address Occupation Parent 2/Guardian Household Information First Name Middle Initial Last Name Relationship to Applicant Is Parent/Guardian a U.S. citizen? Home Phone Number Cell Phone Number Address Occupation 8

9 ESSAY QUESTIONS Anne Morand Question (all candidates) Anne Morand was a deeply knowledgeable art historian in the fields of American Western art and American Indian art. She had a flair for bringing fresh interpretations to the material she presented in publications, lectures, and exhibitions. Above all, she was dedicated to making art come alive for all audiences. Please describe your career aspirations and goals. ( words double-spaced; attach separate page) Personal Essay (all candidates) Write an essay that gives the reader a sense of who you are. Potential areas to consider are experiences that have shaped your understanding of the arts, elements of your upbringing that reflect your interest in museums, scholastic or personal achievements, or any personal theme that intrigues you or is vital to your everyday life and the goals you hope to achieve in your art career. ( words doubled-spaced; attach separate page) Recommendation Letters (all candidates) Submit two letters of recommendation, one from a teacher and one from a nonfamily member outside of school. Samples of Artwork (required for fine arts majors only) If you plan to attend a college or university as a fine arts major, please submit a CD with 6 12 images of your artwork. Please attach a separate sheet listing the titles and media of the works. For Museum Use Only: Date application received: Essays received: Anne Morand Question Personal Essay Recommendation Letters Samples of Artwork SAT or ACT Scores Transcripts 9