The Debutante Process The Arlington Foundation for Excellence in Education, formally the Xi Theta Omega Foundation, in conjunction with the Xi Theta Omega Chapter of Alpha Kappa Alpha Sorority, Inc. appreciates your interest in the 2015 Debutante Scholarship Program. The process offers a range of social, personal, career and educational enrichment opportunities for young ladies. Activities consist of workshops, community service, etiquette training and more! Selected participants learn to successfully transition into the next stage of their high school and college career before taking their bow and being presented to society at the Ball. How To Get Additional Information Attend the information session where Foundation members will answer your questions about the program, registration procedures, training workshops and community service activities. No pre-registration necessary. Information Session will be held at: Saturday, May 2, 2015 3pm University of Texas at Arlington San Saba Rm 2 nd Floor University Center Arlington, TX 76019 For additional information or to R.S.V.P. contact: Alisa Simmons, Eleasia Lewis or Lisa Thompson at scholarships@arlingtoneducation.org 1
Debutante Participation Criteria Must be a high school senior of the class of 2016. Must have a 2.5 cumulative grade point average (Transcript or letter from counselor is acceptable). Must submit two letters of recommendation from individuals outside the family (High School Counselor, Church, or Civic Organization, etc.) Submit a completed Debutante application and biography. Must not be or become pregnant or a mother during the debutante process. Must submit photo and liability release signed by parent or guardian. Must pay the non-refundable participation fee. Must turn in a minimum of $1,500 in combined advertisements/patrons and/or tickets sales in order to be presented. REGULAR APPLICATIONS ARE CURRENTLY BEING ACCEPTED until MAY 31, 2015 LATE APPLICATIONS ARE ACCEPTED FROM JUNE 1, 2015 until JUNE 14, 2015 Applications must be postmarked by the applicable date. If mailing, postmarked application must include payment. Items to submit: o Completed Debutante Application and Biography o Two letters of recommendation o Proof of grade point average Transcript or Progress Report in a sealed envelope from school counselor o Photo and liability release signed by parent or guardian Applications must be postmarked by the applicable date and mailed to: The Arlington Foundation for Excellence in Education Attn: Debutante Scholarship Program 2
P.O. Box 150301, Arlington, Texas 76015 Debutante Participation Requirements Regular Debutante Registration May 2, 2015 May 31, 2015 Participation Fee: $550 Late Debutante Registration June 1, 2015 June 14, 2015 Participation Fee: $600 Participants are required to attend training seminars, meetings, and dance rehearsals. To be considered for a Book Award, Debutantes must turn in a minimum of $2,000.00 in combined advertisements/patrons/ticket sales. Competition begins May 16, 2015, and ends November 4, 2015 Scholarship Ball and Debutante Presentation will take place Saturday, November 21, 2015 3
The Arlington Foundation for Excellence in Education In conjunction with the Xi Theta Omega Chapter of Alpha Kappa Alpha Sorority, Inc. 2015 Debutante Application Name: Address: City, State: Zip Code: Debutante s Phone: High School: Classification: Cum GPA: Email: Is your personal likeness depicted on the Internet or a social media page(s)? If so, please describe where: Do you have a job? If so, list your work schedule below: Mother s Name: Father s Name: Parent s Phone: Work Telephone: Email: I certify to the best of my knowledge that the information provided on this application is true. (Signature of Applicant) (Signature of Parent/Guardian) (Date) (Date) 4
2015 Biography Form Please print or type DEBUTANTE INFORMATION Full Name: Parent(s) Name (first and last): High School: Grade Point Average: Honors and Awards Received: 1) 2) 3) 4) School Activities: 1) 2) 3) 4) Hobbies: 1) 2) 3) 4) Community Service: 1) 2) 3) 4) Name of Church/Religious Organization: List Church or Religious Organization Activities: 1) 2) 3) 5
4) College Attending: Anticipated Major: Career Aspirations: Role Model(s): ESCORT INFORMATION Escort s Name: Parent(s) Name: Address: Escort s Phone: Parent s Phone: Email: School: Significant Extra Curricular Activities: 6
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CONSENT TO PARTICIPATE AND LIABILITY RELEASE I, (parent/guardian name), for myself and on behalf of my child, (debutante name), hereby agree to and accept the requirements and criteria outlined in the 2015 Debutante process, and hereby give permission for my child, to participate in the 2015 Debutante Program and the 2015 Scholarship Ball and Debutante Presentation (the Event ) sponsored by The Arlington Foundation for Excellence in Education in conjunction with the Xi Theta Omega Chapter of Alpha Kappa Alpha Sorority, Inc., (collectively the Sponsors ). I hereby irrevocably and unconditionally release, discharge, and waive any and all claims or causes of action of any nature now or hereafter existing, whether known or unknown against the Sponsors, their agents, employees, officers, members, volunteers, or representatives from any and all responsibility for any injuries or damage sustained by myself or my child arising from any act or omission, negligent or otherwise, of the Sponsors, their agents, employees, officers, members, volunteers or representatives or in connection with the Event. Signed: (Parent/Guardian Signature) Date: 8
PHOTO RELEASE I, (printed name), am the parent or legal guardian of the minor indicated herein. By affixing my signature below, I hereby grant permission to the Arlington Foundation for Excellence in Education and the Xi Theta Omega Chapter of Alpha Kappa Alpha Sorority, Inc., to use the name and likeness of my daughter, (hereinafter minor ), for any and all of its publications, including website entries, without payment or any other consideration. I hereby irrevocably authorize the Arlington Foundation for Excellence in Education and the Xi Theta Omega Chapter of Alpha Kappa Alpha Sorority, Inc., to edit, alter, copy, exhibit, publish or distribute publications featuring the name and likeness of the minor for purposes of publicizing the Arlington Foundation for Excellence in Education and the Xi Theta Omega Chapter of Alpha Kappa Alpha Sorority, Inc., programs and scholarships, or for any other lawful purpose. Arlington Foundation for Excellence in Education or the Xi Theta Omega Chapter of Alpha Kappa Alpha Sorority, Inc., shall not use the name and/or likeness of the minor in any derogatory or demeaning manner. In addition, I hereby waive the right to inspect or approve the finished product, including written or electronic copy, wherein such likeness of the minor appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the name and/or likeness of the minor. Further, I hereby hold harmless and release and forever discharge the Arlington Foundation for Excellence in Education and the Xi Theta Omega Chapter of Alpha Kappa Alpha Sorority, Inc from any and all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf, on behalf of my estate, or on behalf of the minor, have or may have by reason of this authorization. By my signature below, I acknowledge that I have read this release and fully understand the contents, meaning, and impact of this release. A fully executed faxed or scanned copy of this release shall be acceptable. Signature of Parent/Guardian Date 9
Contacts: Alisa Simmons Scholarship Chairman Scholarships@arlingtoneducation.org or arsimmons@outlook.com 817.939.7288 Eleasia Watts-Lewis Scholarship Co-Chairman Scholarships@arlingtoneducation.org or eleasial@sbcglobal.net 214.679.8746 Lisa Thompson Personal Development/Debutante Coordinator Scholarships@arlingtoneducation.org or lisat1122@prodigy.net 817.726.3681 The Arlington Foundation for Excellence in Education Scholarship Website: www.arlingtoneducation.org Xi Theta Omega Website: www.xithetaomega.com 10