BETA THETA, ESA, Scholarship CLERMONT, FLORIDA

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1 BETA THETA, ESA, Scholarship CLERMONT, FLORIDA A deserving high school senior from East Ridge High School, South Lake High School, and Lake Minneola High School will each be awarded $1,500 from Beta Theta to attend Lake Sumter State College. 1. To be eligible, the student must have attended one of the above schools for their entire senior year. 2. Criteria for these scholarships include good character, leadership traits, and a minimum C grade point average. 3. The award will be payable to the recipient through Lake Sumter State College. A completed application includes: This cover page The two-page application Two teacher recommendation forms completed A copy of your resume A 500 word maximum essay covering these 3 topics: What are your future educational plans and career goals? How essential is receiving scholarship money to your ability to attend college? (This scholarship is funded by local individuals who believe your future is important. If you are chosen, you will benefit from their generosity.) In what ways will you give back to your community in the future? The application needs to be submitted to the school s guidance office by April 19, APPLICANT INFORMATION: Name of High School: Student s Full Name: Street Address: City: State: Zip code: Home Phone: ( ) - Cell Phone: ( ) - Address: Parent/Guardian s Name: I have read the information above and wish to apply for a 2016 BETA THETA ESA scholarship. Student s Signature Date To be completed by Guidance Office: DATE RECEIVED

2 BETA THETA, ESA, Scholarship CLERMONT, FLORIDA Applicant s Name: APPLICATION (type or print neatly and complete all questions in full) First Middle Initial Last Permanent Address: City State Zip Parent s Telephone: Student s Telephone: Student s Date of Birth: Student Parent/Guardian Information Father/Guardian Mother/Guardian Name: Employer & Job Title: Applicant lives with: (Name) Please list any other children in the family: Name: (Relationship) Age: Grade: Number of children in the family who will be attending college during Fall 2016: Have you applied for federal financial aid for Fall 2016 using the FAFSA? ( ) Yes If yes, indicate date applied: ( ) No but will apply Explain why you have not applied yet: ( ) Will not apply Explain why you will not apply: Has your family established a Florida PrePaid College account for your educational needs? ( )Yes ( ) No Other Awards Please list below the name and amount of any grants or scholarships that you have been awarded for the upcoming school year. Please describe any extenuating circumstances that would adversely affect your family s ability to contribute to your college or vocational school expenses:

3 List all colleges, universities or vocational schools, in order of preferences, where you have filed applications for admission: Accepted College/University/Vocational School Yes No Pending Intended major: Intended minor: (optional) What career do you plan to pursue? You will be enrolled: ( ) full time ( ) part time List your entire senior class schedule: Course Teacher Course Teacher Other classes YOUR GUIDANCE COUNSELOR MUST COMPLETE THIS SECTION BEFORE YOU MAKE COPIES. Class Rank: out of Unweighted GPA: Weighted GPA: ACT: Eng. Math Read Sci Total Essay SAT: Verbal Math Total Qualify for Florida Academic Scholars Award Florida Medallion Scholars Award Florida Gold Seal Vocational Scholars Award Signed by Guidance official: Parent s or Guardian s Signature Date Applicant s Signature Date I hereby certify that the information given in this application is accurate and complete to the best of my knowledge. I understand that the selection committees will keep my information confidential. To comply with the provisions of the Family Educational Rights and Privacy Act of 1974, your High School must obtain signed authorization before it can release information for use in scholarship programs. By signing above, you are giving school officials permission to release secondary school records and any other requested information for consideration in scholarship decisions.

4 BETA THETA, ESA, Scholarship ~ TEACHER RECOMMENDATION FORM This reference should be given to the teacher well in advance of the due date. Teachers will be filling out many references at this busy scholarship time. Please give a copy of your resume to the teacher. The student is responsible for making additional copies of this recommendation form as needed. Name of Applicant: First Last Directions: Please check ( ) the appropriate rating below. Motivation Creative Qualities Self Discipline College or Voc. School Readiness Intellectual Curiosity Participation in Discussion Classroom Involvement Depth of Understanding Academic Ratings Leadership Self-Confidence Warmth of Personality Concern for Others Personal Responsibility Contributions to School Contributions to Community Overall Character Rating: Character and Personality Ratings How do you know this student? Fill in all that apply: List subjects in which you taught this student: Counselor Team Coach Club Advisor Please include a comment about this candidate: Teachers name: Date: Signature: Position:

5 BETA THETA, ESA, Scholarship ~ TEACHER RECOMMENDATION FORM This reference should be given to the teacher well in advance of the due date. Teachers will be filling out many references at this busy scholarship time. Please give a copy of your resume to the teacher. The student is responsible for making additional copies of this recommendation form as needed. Name of Applicant: First Last Directions: Please check ( ) the appropriate rating below. Motivation Creative Qualities Self Discipline College or Voc. School Readiness Intellectual Curiosity Participation in Discussion Classroom Involvement Depth of Understanding Academic Ratings Leadership Self-Confidence Warmth of Personality Concern for Others Personal Responsibility Contributions to School Contributions to Community Overall Character Rating: Character and Personality Ratings How do you know this student? Fill in all that apply: List subjects in which you taught this student: Counselor Team Coach Club Advisor Please include a comment about this candidate: Teachers name: Date: Signature: Position:

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