PA{ Federal robert C. byrd

Transcription

1 PA{ Federal robert C. byrd Honors scholarship program I ve always believed that the price of success is hard work. So I ve always done my best to excel in school. The Federal Robert C. Byrd Honors Scholarship Program recognized my accomplishments and now I can afford to attend the college of my dreams. Success is sweet.

2 INSTRUCTIONS FOR COMPLETING THE APPLICATION FORM FOR THE PENNSYLVANIA FEDERAL ROBERT C. BYRD HONORS SCHOLARSHIP PROGRAM DIRECTIONS The accuracy of the information on the application must be verified by the guidance counselor or school authority and all documents must be submitted by the school official. The student and school personnel are responsible for assuring that applications are complete and are submitted on time. The completed application must be received on or before the DEADLINE DATE of APRIL 1, The eligibiliy requirements and the selection process are provided on page 5. A checklist for students and school personnel is provided on page 6. PART I: To be completed by the student applicant (please complete the grey boxes) You must submit one copy of a letter of acceptance to an eligible institution of higher education. The particular institution named will have no bearing on the selection of recipients (unless it is from institutions which do not accept Federal Title IV funds, such as Grove City College, Hillsdale College, or a U.S. Military Academy) and the letter does not have to be from the institution of your final choice. If you are qualifying under the GED requirement, it is not necessary to have PART II completed by high school personnel. Simply complete PART I and submit this form with a letter of acceptance to an institution of higher education, a notarized copy of your GED score sheet and your SAT or ACT scores. Attach your letter of acceptance to the application form and return both to your guidance counselor or school authority. Certificate of Eligibility for Federal Assistance Form - signed and dated (page 4 of application). If you are a homeschooled student, you must submit a copy of your official SAT or ACT School Report and have your homeschool evaluator complete Part II on page 3. PART II: To be completed by the school s guidance counselor or school authority (please complete the grey boxes) If the procedures below are not followed, the student's application will be disqualified. Convert GPA to an UNWEIGHTED 4.0 SCALE. Place official class rank and UNWEIGHTED GPA on both transcript and application. Place the SAT/ACT scores in the approriate boxes on the application. School seal must be on BOTH the application and the transcript. SENIOR MID-YEAR GRADES MUST be on the transcript. SAT scores on the application should be the TOTAL of the HIGHEST Critical Reading and HIGHEST Math only. Do not include the writing component score. A copy of the official SAT or ACT School Report must be submitted for all students, including homeschooled students. If you are a private school, indicate in which school district your school is geographically located. Include copy of ANY college acceptance letter (needed only to verify that student is accepted by a college). NOTE: Leave Part II blank if student obtained a high school diploma via GED. SCHOOL OFFICIAL PLEASE MAIL TO: SS RBAP PS 12/10 When all parts of this application have been completed, send the materials to: PHEAA Pennsylvania Federal Robert C. Byrd Honors Scholarship Program PO Box 8157 Harrisburg, PA In order for an application to be considered, it must be received on or before April 1,

3 SS RBAP PS 12/ APPLICATION FORM PENNSYLVANIA FEDERAL ROBERT C. BYRD HONORS SCHOLARSHIP PROGRAM (TYPE OR PRINT Complete all required information) Application Deadline: APRIL 1, 2011 Do Not Apply If You Do Not Meet All Of The Criteria Shown On Page 2 In "Eligibility Requirements." PART I: Student Application Section (Page 2 - eligibility requirements and directions) TBAP 09 SOCIAL SECURITY NUMBER FIRST NAME MI LAST NAME ACADEMIC YEAR STREET ADDRESS (NOTE - P.O. Box addresses must be accompanied by a street address) CITY STATE ZIP HOME TELEPHONE BIRTH DATE(mmddccyy) Pennsylvania Resident (Y or N) U. S. Citizen (Y or N) If NO, enclose a copy of your Lawful Permanent Residence Card I-551. Certificate of Eligibility for Federal Assistance Form signed and dated (Form found on page 4). Yes No GED score date(mmddccyy) * SIGNATURE OF APPLICANT DATE SIGNED (mmddccyy) * Failure to provide requested information from you or school authority may make you ineligible for the award. PART II: High School Guidance Counselor Section (Page 2 - eligibility requirements and directions) 1. List applicant s official class rank after mid-year grades of senior year. These mid-year grades should be included with the transcript. If school does not rank, guidance counselor or school authority MUST provide the applicant s ESTIMATED RANK in item 1 and also ON THE OFFICIAL TRANSCRIPT. (Number) out of (Total number of students in applicant s class). 2. Unweighted grade point average (GPA) (Grades 9 through mid-year of senior year converted to a 4.00 scale/ unweighted). NO GPA ABOVE A 4.00 WILL BE ACCEPTED. CONVERTED GPA MUST ALSO APPEAR ON TRANSCRIPT. 3. SAT total score (Critical Reading and Math only) or ACT composite score All students, including homeschooled students, must submit a copy of the official SAT or ACT School Report with their application; TOEFL scores not accepted). 4. County Code of Student Residence See page 5 for County Codes. 5. High School Code This is your high school's six digit College Entrance Examination Board (CEEB)#. 6. School District I certify that the above information (Part I & Part II) is accurate and I understand that failure to provide the requested information by April 1, for any reason, may cause the student s application to be ineligible for the award. Place Date(mmddccyy) School Seal School Phone No. Here Official's Title First Name Last Signature of Guidance Counselor or School Authority 3 High School Address

4 Certification of Eligibility for Federal Assistance in Certain Programs I understand that 34 CFR 75.60, 75.61, and require that I make specific certifications of eligibility to the U.S. Department of Education as a condition of applying for Federal funds in certain programs and that these requirements are in addition to any other eligibility requirements that the U.S. Department of Education imposes under program regulations. Under 34 CFR : I. I certify that: A. I do not owe a debt, or I am current in repaying a debt, or I am not in default (as that term is used at 34 CFR Part 668) on a debt: 1. To the Federal Government under a nonprocurement transaction (e.g., a previous loan, scholarship, grant, or cooperative agreement); or 2. For a fellowship, scholarship, stipend, discretionary grant, or loan in any program of the U.S. Department of Education that is subject to 34 CFR 75.60, 75.61, and 75.62, including: * Federal Pell Grant Program (20 U.S.C. 1070a, et seq.); * Federal Supplemental Educational Opportunity Grant [FSEOG] Program (20 U.S.C. 1070b, et seq.); * Leveraging Educational Assistance Partnership Program (LEAP) (Formerly State Student Incentive Grant Program [SSIG]) (20 U.S.C. 1070c, et seq.); * Federal Perkins Loan Program (20 U.S.C. 1087aa, et seq.); * Income Contingent Direct Loan Demonstration Project (20 U.S.C. 1087a, note); * Federal Stafford Loan Program, Federal Supplemental Loans for Students [SLS], Federal PLUS, or Federal Consolidation Loan Program (20 U.S.C. 1071, et seq.); * Cuban Student Loan Program (20 U.S.C. 2601, et seq.); * Robert C. Byrd Honors Scholarship Program (20 U.S.C. 1070d-31, et seq.); * Jacob K. Javits Fellows Program (20 U.S.C. 1134h-1134I); * Patricia Roberts Harris Fellowship Program (20 U.S.C. 1134d-1134g); * Christa McAuliffe Fellowship Program (20 U.S.C I); * Bilingual Education Fellowship Program (20 U.S.C ); * Rehabilitation Long-Term Training Program (29 U.S.C. 774(b)); * Paul Douglas Teacher Scholarship Program (20 U.S.C. 1104, et seq.); * Law Enforcement Education Program (42 U.S.C. 3775); * Indian Fellowship Program (29 U.S.C. 774(b)); * Academic Competitiveness Grant (ACG); * The National Science and Mathematics Access to Retain Talent (SMART) Grants; * Teacher Education Assistance for College and Higher Education (TEACH) Grant Program; OR B. I have made arrangements satisfactory to the U.S. Department of Education to repay a debt as described in A.1. or A.2. (above) on which I had not been current in repaying or on which I was in default (as that term is used in 34 CFR Part 668). II. I certify also that I have not been declared by a judge, as a condition of sentencing under Section 5301 of the Anti-Drug Abuse Act of 1988 (21 U.S.C. 862), ineligible to receive federal assistance for the period of this requested funding. I understand that providing a false certification to any of the statements above makes me liable for repayment to the U.S. Department of Education for funds received on the basis of this certification, for civil penalties, and for criminal prosecution under 18 U.S.C _ (Typed or Printed Name) (Signature) (Date) Name or number of the USDE program under which this certification is being made: Federal Pennsylvania Robert C. Byrd Honors STUDENT PLEASE NOTE: Sign/date Certificate of Eligibility for Federal Assistance form and attach transcript with letter of acceptance to an eligible institution of higher education to the application. 4

5 ELIGIBILITY REQUIREMENTS REQUIREMENTS Apply ONLY IF you meet ALL of the criteria... NO EXCEPTIONS! 1. All of the following three Educational Standards must be met (except General Educational Development Diploma(GED) recipients; see *NOTE) a. Hold an official class rank in the top 5 percent of your graduating class or hold a ranking of 1, 2 or 3 in classes of 60 students or less; b. Have a grade point average equal to a 3.50 or above on a 4.00 scale (unweighted); c. Have a Scholastic Aptitude Test (SAT) total score of 1150 or above (Critical Reading & Math scores only) or an American College Testing (ACT) composite score of 25 or above. Test of English as a Foreign Language (TOEFL) scores not accepted. 2. You must expect to be a full-time freshman student enrolled at an accredited institution of higher education that participates in the Federal Title IV Student Aid Programs, in the United States, for the school year. 3. Submittal of application, seal, official transcripts, a copy of the SAT or ACT School Report, signatures and an attached letter of acceptance from an institution of higher education. ATTENTION: Students who attend Institutions which do not accept Federal Student aid funds, such as Grove City College, Hillsdale College, and the U.S. Military Service Academies, are not eligible to receive Byrd Scholarships. 4. You must receive your high school diploma the same year as the application. 5. Continuing Eligibility A student must be enrolled full-time for his/her first year of study. To remain eligible for scholarship renewal a student must continue to meet the citizenship, legal residence and enrollment requirements plus maintain satisfactory academic progress as determined by the institution of higher education the student is attending. *NOTE: If you obtained a high school diploma by following GED procedures, your GED score must be at least A notarized copy of your GED score sheet must accompany the application. In addition, you must have at least an 1150 SAT score (total of the Highest Critical Reading and Highest Math only) or 25 ACT score and a copy of your scores must also be attached to your application. SELECTION PROCESS Final selection of all qualified applicants will be done by a random selection from each county in Pennsylvania. The number of awards from each county will be determined by the amount of monies allocated by the Federal Government. Awards for this program, new and renewal, are contingent upon federal funding for and beyond. COUNTY CODES 01 Adams 02 Allegheny 03 Armstrong 04 Beaver 05 Bedford 06 Berks 07 Blair 08 Bradford 09 Bucks 10 Butler 11 Cambria 12 Cameron 12 Cameron 13 Carbon 14 Centre 15 Chester 16 Clarion 17 Clearfield 18 Clinton 19 Columbia 20 Crawford 21 Cumberland 22 Dauphin 23 Delaware 24 Elk 25 Erie 26 Fayette 27 Forest 28 Franklin 29 Fulton 30 Greene 31 Huntingdon 32 Indiana 33 Jefferson 34 Juniata 35 Lackawanna 36 Lancaster 37 Lawrence 38 Lebanon 39 Lehigh 40 Luzerne 41 Lycoming 42 McKean 43 Mercer 44 Mifflin 45 Monroe 46 Montgomery 47 Montour 48 Northampton 49 Northumberland 50 Perry 51 Philadelphia 52 Pike 53 Potter 54 Schuylkill 55 Snyder 56 Somerset 57 Sullivan 58 Susquehanna 59 Tioga 60 Union 61 Venango 62 Warren 63 Washington 64 Wayne 65 Westmoreland 66 Wyoming 67 York 5

6 COMPLETING THE APPLICATION FOR THE FEDERAL ROBERT C. BYRD HONORS SCHOLARSHIP PROGRAM Please use this checklist as a way to double check that all the required items on the application have been filled out before the application is sent to PHEAA. CHECKLIST Student Application Section (all application items below are mandatory) Social Security Number First Name & Last Name Street Address (Note - P.O. Box addresses must be accompanied by a street address) City State Zip Home Telephone Birth Date (MMDDCCYY) Pennsylvania Resident U.S. Citizen Copy of your Lawful Permanent Residence Card (If Applicable) Certificate of Eligibility for Federal Assistance Form - Signed and Dated (form found on page 4) GED Score and Date (If Applicable) Copy of GED Score (If Applicable) Signature of Applicant & Date Signed (MMDDCCYY) Guidance Counselor Section (all application items below are mandatory) Applicant's official class rank (class rank number and total number of students in the applicant's class) Unweighted Grade Point Average (GPA) on 4.0 unweighted scale SAT total score (Critical Reading and Math only) or ACT composite score County Code of student residence (see page 5 for County Codes) High school code (this is your high school's six digit College Entrance Examination Board (CEEB) number) School district (if a private school, provide the school district where the school is located) Date (MMDDCCYY) School phone number Official's title First Name & Last Name Signature of Guidance Counselor or School Authority High school address (preferably a general address, if available) Place School Seal Here Items that must be submitted with the application Official Transcripts for Grades 9 through mid-year of senior year Letter Of Acceptance from an Institution of Higher Education (Excluding Grove City College, Hillsdale College, and Military Academies) Completed "Certification of Eligibility for Federal Assistance in Certain Programs" Form (Page 4) A copy of the official SAT or ACT School Report Home-schooled students who will not receive a high school diploma from a PDE-recognized home-school organization only: certification from the superintendent of student's local school district that their home education complies with the Home Education Law (24 P.S ) 6