Telephone Number Religious Affiliation Name & address of church where you are a member

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1 The Wasie Scholarship Program Application for the Academic Year APPLICATION MUST BE POSTMARKED NO LATER THAN MARCH 15, 2013 FOR USE BY CITIZENS OF THE U.S.A. OR PERMANENT LEGAL RESIDENTS ONLY Please read all instructions carefully, before completing this application. Application omissions or mistakes will automatically disqualify you from being considered for a scholarship. Please type or print in black or blue ink. PERSONAL INFORMATION Male Female address: Last name First name Middle name Date of birth City and Country of birth Home Street Address City State Zip code Country Telephone Number Religious Affiliation Name & address of church where you are a member Are you married? Yes No If yes, what is the full name of your spouse? What is the occupation of your spouse? Name and address of your spouse s employer FAMILY INFORMATION Biological father s full name % Polish (if applicable) Street address City State Zip code Country Telephone number Occupation Name of Employer Biological mother s full name % Polish (if applicable) Street address City State Zip code Country Telephone number Occupation Name of Employer APPLICATION STATUS This is my first Wasie Scholarship application being submitted I have previously applied for a Wasie Scholarship, but have not received one. The year(s) applied 1

2 INSTITUTIONAL STATUS: CLASS STANDING WHAT LEVEL WILL YOU BE IN SEPTEMBER 2013? CHECK ( ) ONE: Freshman Sophomore Junior Senior Major Anticipated Graduation Date (month and year) Law School (Hamline University or William Mitchell College of Law ONLY) 1 st year 2 nd year Anticipated Graduation Date (month and year) The following schools have Domestic Wasie Scholarship programs. Please indicate the school(s) where you have applied & have been accepted for enrollment: Dunwoody College of Technology College of St. Benedict Hamline University University of St. Thomas St. John s University William Mitchell College of Law EDUCATIONAL HISTORY Please list all schools attended from high school to present (prior to August of 2013). Include school names and addresses, dates attended, level of education attained, and grade point average (GPA) or equivalent. Please note any degree or diploma received. IF THIS SECTION IS NOT COMPLETED IN ITS ENTIRETY, YOUR APPLICATION WILL BE DISQUALIFIED. NAME & ADDRESS OF INSTITUTION ATTENDED DATES ATTENDED LEVEL OF EDUCATION ATTAINED GPA OR EQUIVALENT DEGREE/DIPLOMA CERTIFICATE Circle exams taken and provide score: SAT / ACT Score: LSAT / MCAT / GRE Score: CITIZENSHIP Check ( ) one: United States Poland Dual United States/Poland CERTIFICATION & AUTHORIZATION Review & sign this application. Unsigned applications will NOT be considered. By signing below, I certify that I have read, and understand, my responsibilities in completing this application package. I certify that all of the information in this application package, including the application form, narrative, and transcripts, is true and complete to the best of my knowledge. If at some time it is determined that the information I submitted is untrue, the Wasie Scholarship award, if granted, will be terminated, and any funds received by me will be refunded to the Wasie Scholarship Program at the institution I am attending. I certify that the narrative is my own work. I hereby authorize the release and exchange of any information, including grade point average and/or transcripts, requested from my college/university by The Wasie Foundation or its representatives regarding this scholarship application, any subsequent Wasie Scholarship award, and reports required by The Wasie Foundation. Signature Date 2

3 NARRATIVE A written narrative should address the seven items noted below. The narrative must be typed and double spaced and may not exceed three pages in length. You may not use a font smaller than 10 point. Your name must be typed in the upper left hand corner of each page. ALL seven items noted below must be addressed, and they must be addressed in the order given. If you fail to address each item, or do not address each item in the order noted, your application will be disqualified and will NOT be considered. 1. Your Polish family history is important to The Wasie Foundation because the founder of The Wasie Foundation was a Polish immigrant to the United States of America. Mr. Wasie initially established The Wasie Foundation to help provide education for students of Polish ancestry. Mr. Wasie was extremely proud of his Polish heritage. Briefly tell us about yourself, your family of origin, your Polish family history, and the role your Polish ancestry has played in your life. 2. Describe your academic goals. 3. Describe your current career goals. 4. Describe your most recent achievements. 5. Describe your current community involvement (paid employment, volunteer work, other things outside of school clubs and organizations). 6. Describe your personal interests. 7. Tell us about your current extra-curricular school activities. If needed, once the above seven points have been addressed in your narrative, you may address any special or unusual circumstances that should be considered. YOUR NARRATIVE MUST BE ORIGINAL/NEW EACH YEAR. ANY PORTION COPIED FROM A PREVIOUSLY SUBMITTED APPLICATION TO THE WASIE FOUNDATION WILL RESULT IN IMMEDIATE DISQUALIFICATION. 3

4 QUALIFICATIONS AND PREFERENCE CRITERIA The Wasie Foundation plays a consultative role in reviewing applications for the academic institutions, which make the final decision as to which students are awarded Wasie scholarships. The Wasie Foundation suggests those students to the schools who best meet the Foundation s criteria based on financial need, academic ability, and the written narrative. Preference is given to Christian individuals of Polish ancestry with financial need. The schools make the final decision about scholarship recipients and awards. INSTITUTIONAL STATUS The Wasie Foundation provides funds to select academic institutions, which use the funds to award individual scholarships. To receive a Wasie Scholarship, you must apply as a full-time student, and ultimately be accepted by that institution. The Wasie Scholarship is based on financial need and the submitted narrative. Before a scholarship can be awarded by an academic institution, financial need must be determined. You must apply for financial aid through the institution(s) you have indicated on this application by the deadline (March 15, 2013). The final decision about scholarship recipients and awards is the responsibility of the academic institutions. You will be notified by the academic institutions to which you applied as to whether or not they have selected you to receive a Wasie Scholarship. The Wasie Foundation will NOT provide information concerning the selection of scholarship recipients to applicants. The final decision about scholarship recipients and awards is the responsibility of the academic institutions. APPLICATION REQUIREMENTS SEE CHECKLIST ANSWERS TO NARRATIVE QUESTIONS SEE PAGE 3 A written narrative addressing seven criteria outlined within this application must be submitted. This narrative must be typed and double spaced. POLISH ANCESTRY DOCUMENTATION If you have not previously received a Wasie Scholarship, you must provide proof of Polish ancestry. Copies of birth certificates, death certificates, passports, immigration records, or naturalization papers may be used to show the line of descent from the applicant to the ancestors born in Poland. You must show Polish family lineage from each parent. Letters from relatives are not valid proof of descent. If you are a permanent, legal resident, you must provide copies of your passport and your green card. DO NOT SEND ANY ORIGINAL DOCUMENTS TO THE WASIE FOUNDATION. SEND ONLY COPIES. OFFICIAL TRANSCRIPTS Your application must include OFFICIAL transcripts from your last THREE FULL YEARS of school. This applies to all applicants, even if you are a previous Wasie Scholarship recipient. If you are currently attending college, please also include your fall OFFICIAL transcript. Contact your school(s) to get your official transcripts or to have them sent directly to The Wasie Foundation. FOR MORE INFORMATION Your questions should be directed to the Admissions/Financial Aid Office at the school(s) where you have applied. 4

5 OVERVIEW 1. Your completed Wasie Scholarship application package MUST BE POSTMARKED AND MAILED NO LATER THAN MARCH 15, Your OFFICIAL transcripts, if submitted separately by the school(s), MUST BE POST-MARKED AND MAILED NO LATER THAN MARCH 15, Any items received with a postmark past the deadline will result in disqualification. IMPORTANT DATES MARCH Your completed Wasie Scholarship application is due: MARCH 15, APRIL You will receive confirmation by that your application has been received. MAY-JULY You will be notified of your award status by the academic institution to which you applied. CHECKLIST Your application package must include the following materials. Use the checklist below, placing a in each box as you assemble your materials. Application form Narrative Proof of Polish ancestry Official transcripts from last three (3) years of school (see Official Transcripts section on page four and read carefully) Enclosed Sent directly by the school(s) fall semester OFFICIAL transcript if currently attending college Enclosed Sent directly by the school Make certain you have signed the certification and authorization LATE OR INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. Mail your application package to: The Wasie Foundation Scholarship Program 230 Manitoba Avenue South, Suite 110 Wayzata, MN U.S.A. Applicants may wish to obtain proof of mailing and you may wish to keep a copy of this application form and other materials being submitted to The Wasie Foundation. 5

6 YOUR APPLICATION WILL NOT BE CONSIDERED & YOU WILL BE DISQUALIFIED IF YOU DO NOT FOLLOW THE DIRECTIONS ON THE APPLICATION FORM! FOR EXAMPLE, YOU MAY BE DISQUALIFIED IF YOU: Fail to complete the application form in its entirety If you leave a line blank, or incomplete (for example, no address for the schools you previously attended) you will be disqualified. If something does not apply, use N/A (meaning Not Applicable) on the form. Fail to double space the narrative as directed Fail to type your name in the upper left hand corner of each page Fail to provide an address Fail to submit official transcripts Transcripts from schools must arrive with your application materials in a sealed envelope with the school seal/stamp from the registrar s office, or directly from the school. Transcripts printed by the applicant from the school s website will not be accepted and you will be disqualified. Fail to submit three full years of transcripts postmarked by the deadline (even if transcripts were to be sent directly by the schools, this is still the applicant s responsibility) Fail to sign the application form (the certification and authorization) Fail to address all of the application requirements that were to be included in the essay/narrative Fail to provide adequate proof of Polish ancestry Other reasons for which you maybe be disqualified: Criteria/questions not well addressed in the essay/narrative Application was not postmarked by the deadline Providing false ACT/SAT/other test scores on the application form Completing an application form from a previous year(only current application forms are accepted) Polish ancestry and history is a very important part of the essay/narrative, as this is the primary basis for the development of The Wasie Foundation s Scholarship Program. 6