Suzanne Gooder/WOTM Scholarship Program SCHOLARSHIP APPLICATION PRIVACY ACT STATEMENT

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1 PRIVACY ACT STATEMENT ELIGIBILITY: The Award is a scholarship of $2,500.00, to be awarded to an accredited institution of higher learning by the Suzanne Gooder/WOTM Scholarship Program in the name of and for use by a student who meets all of the following criteria: 1. Must be a Fort Walton Beach High School student graduating in the school year that the award is given and meet any SAT or ACT requirements of selected college or university. 2. Must maintain a 2.50 GPA or better for the year the student graduates. This scholarship winner will be announced Senior Awards Night. If the applicant s GPA falls below 2.50 prior to Senior Awards Night, then that applicant will be deemed ineligible. 3. Must have firm plans to attend an accredited Community College, College/University or Technical School as a full time student (12 hours or more), in the year following graduation from Fort Walton Beach High School. 4. Must complete a Scholarship Application in its entirety, including essay, and submit it to the Fort Walton Beach High School Guidance Center no later than March 12, Please use black ink. APPLICATIONS THAT ARE SUBMITTED INCOMPLETE IN ANY WAY OR AFTER THE DEADLINE WILL NOT BE CONSIDERED. THERE WILL BE NO EXCEPTIONS. 5. Finalists will be selected from the applications submitted to the Fort Walton Beach High School Guidance Center that meet or exceed all criteria. The Suzanne Gooder/WOTM Scholarship Program Committee will interview finalists and a scholarship recipient will be selected. All decisions are final. PRINCIPAL PURPOSE: To provide information on the Applicant s academic, extracurricular and related experience solely for the use of the in determining scholarship award winners. Once submitted, all applications become the exclusive property of the. ROUTINE USE: Used only by the to evaluate the Applicant s relative suitability for scholarship awards. With the exception of the recipient, all applications are destroyed. DISCLOSURE: Disclosure is voluntary on the part of the Applicant;; however, the Application form must be completed to satisfy the eligibility criteria. INFORMATION ABOUT THE APPLICANT (please use black ink): NAME:

2 (Last) (First) (M.I.) HOME ADDRESS: (Street Address) (City) D.O.B.: / / PLACE OF BIRTH: HOME PHONE NUMBER: ( ) - MOBILE PHONE NUMBER: ( ) - ***BE CERTAIN TO INCLUDE A RECENT PHOTOGRAPH***

3 REFERENCES: Please provide TWO letters of recommendation. One must come from a teacher familiar with your academic skills. The second may come from either a teacher or community member (not a relative) who is familiar with you. ACADEMIC ACHIEVEMENTS AND AWARDS: (Use extra sheet if necessary) Honor or Achievement Date / / / / EXTRACURRICULAR ACTIVITIES, HONORS AND EMPLOYMENT EXPERIENCE: Please include only those items you feel make you a better candidate for the award of this scholarship. (Use extra sheet if necessary) Examples might include: soccer team player, library volunteer, civic awards, helped Mom/Dad around the house, etc. Activity/Honor/Work Experience Date ACADEMIC PLANS: Include in the space below, a brief statement of your college intentions, including the name of the school, planned entry date and major. Use an extra sheet, if necessary: ESSAY: On a separate piece of paper, describe in words, any hardships you may have overcome in your life. We are also interested in ways you have contributed to your family and community and what you hope to accomplish with a college or technical degree. This essay is the major factor considered by the in determining the scholarship recipient. I hereby certify that all of the information submitted herein is true and correct to the best of my knowledge and belief. I further agree that if awarded this scholarship, I will make myself available for a presentation photograph that can be used for publication by the Suzanne Gooder/WOTM Scholarship Program. Applicant s Signature Date Parent or Legal Guardian Date End of Application CHECKLIST: Have you given the information sheet about your transcript and current GPA to your guidance counselor for him/her to fill out? Have you included that information sheet with your

4 application? Have you filled in all information in black ink and enclosed a recent photograph? Have you included your essay? STUDENT DATA AND RECOMMENDATION FORM Please attach a copy of the student s official transcript, any recommendations and complete the following information: STUDENT S NAME: (Last) (First) (M.I.) 1. Number in graduating class. 2. Student s class ranking. 3. Student s percentile ranking. 4. Student s GPA (Min 2.50 based on Okaloosa County s weighted scale) 5. Student s combined SAT score 6. Student s ACT score. It is requested that a duly authorized representative of Fort Walton Beach High School complete this form and retain it in the school office until the student turns in the completed application. Retain this form along with the student s application in the Guidance Center until collected by the Suzanne Gooder/WOTM Scholarship Program Scholarship Committee. Counselor s Signature/Printed Name/ Date Guidance Counselor s recommendations (your comments are important): Has the Student Resource Officer had any dealings with this student? Yes / No If yes, please explain:

5 Additional Notes: Students Each year approximately four to six applicants are chosen for an interview. The interview is spontaneous without prior notification. They are held at the High School and you will be called out of class and given the opportunity to talk to the Committee. In preparation for this, take the time after you have submitted your application to prepare yourself for the interview. This preparation time will also prepare you for future interviews for jobs, colleges and perhaps even other scholarships. Think about your goals, the colleges you are considering, possible challenges and any other information about yourself that makes you unique or simply you. If you have any questions, please do not hesitate to check in with your Guidance Counselor. Good Luck!