LAKEWOOD HIGH SCHOOL LOCAL SCHOLARSHIP PORTFOLIO CLASS OF Insert One Photo Applicant s Name First Middle Last
Name of Applicant Birth date: Address: Phone: Age: Post High School Plans College or school you plan to attend: Have you been accepted? Yes Applied, Waiting Have not yet applied Intended Major/Area of Interest: Father/Guardian Name: Place of Employment: Home Phone: Work Phone: Position: Full-time: Part-time: Mother/Guardian Name: Place of Employment: Home Phone: Work Phone: Position: Full-time: Part-time: Dependent Students List other members of your immediate family who will be attending any school during your freshman year of college. State each of their ages and grade levels. First Name Only Age Grade First Name Only Age Grade Other Dependents List other members in your household, such as a grandparent or other family member, if they were claimed on the previous year s tax return. Release of Information: I give my permission for the information contained in my scholarship notebook to be reviewed by the scholarship screening committees: Student Signature Date Parent/Guardian Signature Date
Specific Student Information: Required for specific scholarships Origin(s) of Nationality (ie, German, French, Norwegian, etc) There are Veterans in my immediate or extended family? Yes List_ I have attended Lakewood Schools since Kindergarten Yes I have taken or am currently enrolled in greenhouse/horticulture classes Yes Educational Information: Ask Your Counselor for this information Cumulative GPA Rank in Class of Students Test Scores (if applicable) SAT Critical Reading Math Writing Total ACT English Math Composite High School Courses: College Prep/Advanced Placement Classes Special Interest Classes (ex: Art, Web Design, etc.) List the honors and awards you have received. Give a brief description and X the appropriate category You may add an additional sheet if necessary. HONOR/AWARD GRADE DESCRIPTION 9 10 11 12 Example: Science Award X Outstanding classroom achievement
In the left column, list your major activities and mark an X for the year(s) during which you participated. In the right column, list any leadership positions you held as part of that activity or any contributions you made, and mark an X in the grade level it occurred. One entry per line please. You may attach an additional sheet if needed. STUDENT ACTIVITIES GRADE LEADERSHIP and/or ACCOMPLISHMENTS GRADE 9 10 11 12 9 10 11 12 Team Captain: Organized tournaments. Example: Debate Team X X X Trained first-year debaters X List the most significant work experiences you have held during the past four years, beginning with the most recent. NAME and ADDRESS of EMPLOYER POSITION HELD FROM MO/YR TO MO/YR HRS/ WK
List ways in which you have helped your community. Only one entry per line. You may attach an additional page if needed. Must include supervisor s signature to validate. SERVICE ACTIVITY DESCRIPTION TOTAL HOURS SUPERVISOR S (approximate) SIGNATURE Statement of Financial Need required Use this space to comment regarding your individual financial need circumstances. FAFSA: Have applied Will apply Will not apply All applications for financial assistance programs, i.e. grants, scholarships, special funds, prizes, etc., will be considered by Lakewood School District #306 without regard to race, color, national origin, gender, or handicap.
Personal Statement Limit your comments to this page--front side only. A typed copy can also replace this page (double spaced, font size 10, signed). Choose one of the following topics and include your question at the top of your essay: 1. How will your individual background, experiences and personal identity influence your educational pursuits? 2. Write about a meaningful activity you have participated in and it s influence in your life. 3. Indicate a person who has had a significant influence on you and describe that influence. Student Signature:
LHS Teacher Recommendation Teacher s Name: Student s Name: A SIGNED, TEACHER LETTER OF RECOMMENDATION MAY REPLACE THIS PAGE. Personal Data Form available in Counseling Office or Career Center. Please list the classes this student has taken from you as well as other capacities in which you have worked with him or her. What are the first words that come to your mind when describing this student? Does this student s achievements reflect his/her ability? In what way has this student been memorable? We are especially interested in things that might distinguish this student from other students seeking local scholarships. Signature
Community Member Recommendation Evaluator s Name: Student s Name: A SIGNED, COMMUNITY MEMBER LETTER OF RECOMMENDATION MAY REPLACE THIS PAGE. Personal Data Form available in Counseling Office or Career Center. How long and in what capacity have you known this student? What are the first words that come to your mind when describing this student? Does this student demonstrate curiosity and initiative? Does she/he demonstrate good problem-solving skills, follow through, and task completion? We benefit from your perspective of the student s personal qualities and contribution to the community. What would you like us to know about the student that we might not otherwise learn? Please limit your comments to the space below. Signature