BRIAN TERRY FOUNDATION SCHOLARSHIP PROGRAM ACADEMIC YEAR

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BRIAN TERRY FOUNDATION SCHOLARSHIP PROGRAM 2017-2018 ACADEMIC YEAR PROGRAM OBJECTIVES The Brian Terry Foundation is a nonprofit organization formed to honor the memory of fallen U.S. Border Patrol Agent, Brian A. Terry. One of the key missions of the Brian Terry Foundation is the provision of providing college scholarships to young men and women who exemplify the qualities of justice, honor, and accountability, qualities personified by Brian Terry during his lifetime. Because education is a crucial stepping stone to success, the Brian Terry Foundation recognizes the importance of supporting students as they pursue academic excellence. The Brian Terry Scholarship is unique for the fact that it is intended for students intending to study criminal justice or a related field of study and eventually seeking a career in law enforcement. The Brian Terry Foundation Scholarship Program supports this mission by providing financial support to students who are preparing to or already attending college. As a Brian Terry Foundation scholarship recipient, students will receive financial assistance with the costs and expenses associated with attending college. Brian Terry Scholars MUST be accepted to or be attending college. Brian Terry Scholars MUST be intending to study criminal justice or a related field of study. Brian Terry Scholars MUST be currently seeking an undergraduate degree. AWARD Applications will be accepted beginning in January 2017. We are currently accepting Brian Terry Scholarship Program applications for the 2017-2018 academic year. Scholarship applications will be accepted and evaluated on a first-come, first-serve basis. The application process will close once the Brian Terry Foundation receives 100 applications for the 2017-2018 academic year. Applicants who are not accepted for the 2017-2018 academic year will, at their request, be put on a waitlist for the next academic year and will be required to submit an update to their application when the application process reopens. INSTRUCTIONS

DEADLINE for applications is May 31, 2017. Provide all supporting documents (i.e., reference forms, evidence of GPA, etc.). Incomplete applications will not be considered. If any question does not apply to you put N/A in the space provided. Type or print legibly. Illegible applications will be returned to you. You will be notified by mail in August 2017 regarding the status of your application. CRITERIA Applicant must have a minimum GPA of 3.0 on a 4.0 scale. Applicant must be a United States Citizen or Legal Resident of the United States. Applicant must be a graduating high school senior in May 2017 or currently attending or planning to attend college and seeking an undergraduate degree. Applicant must demonstrate the following: goals and achievement; positive impact on community; commitment to social justice; and prior academic success. Sponsorship funds will be awarded to the student upon evidence of registration in an accredited post-secondary institution. APPLICATION PROCESS Applicant must submit the following items: 1. Completed application form (if handwritten, please print legibly in black or blue ink) Postmarked no later than May 31, 2017. 2. Two (2) completed recommendation forms from applicant s choice of high school teachers, college professors, administrators, counselors, employers, non-family members. Recommendation forms must be mailed, by the reference, in a sealed envelope directly to the Brian Terry Foundation. 3. An official and recent high school or college transcript including cumulative grade point average. 4. Personal Essay: (1,500 Character Limit) 5. Two (2) self-addressed stamped envelopes. One will be used to acknowledge receipt of your application and the other will notify you of your scholarship application results. You will be notified via e-mail once your application is received. Once all applications have been reviewed, you will be notified in July 2017 via regular mail and telephone if you have been accepted as a Brian Terry Scholar. DEADLINE for the application is May 31, 2017. Applications postmarked after this date will not be considered. Please mail application to: BRIAN TERRY FOUNDATION SCHOLARSHIP PROGRAM BRIAN TERRY FOUNDATION

2575 EAST CAMELBACK ROAD, Suite 1100 PHOENIX, AZ 85016

2017 BRIAN TERRY FOUNDATION SCHOLARSHIP PROGRAM APPLICATION PERSONAL INFORMATION Legal Name: Student ID #: Gender: Male Female Nickname, other name, or former last name(s), if any: Birth date (mm/dd/yyyy): Are you applying as a Freshman Sophomore Junior or Senior in college? Or a graduating high school senior? E-mail Address: Current high school: College Enrollment Date: Permanent Home Address: (Number and Street, City or Town, State, Zip Code) Permanent Home Phone: Cell Phone: If different form above, please give your mailing address for all correspondence. Mailing Address: (Number and Street, City or Town, State, Zip Code)

This will be your mailing address (mm/yyyy) from to. Phone at mailing address: Citizenship: Circle One: US citizen Dual US citizen; please specify other country of citizenship: US Permanent Resident Visa; citizen of: Alien Registration Number: Which institution do you attend or will you attend in Fall 2017: (Proof of acceptance or current student enrollment form the above school is required prior to disbursement of funds.) Possible areas(s) of academic concentration/major(s) (or undecided): Accurate college address (ie: Financial Aid Office) to send scholarship check to: Possible career or professional plans (or undecided): Name & address of parent(s) or legal guardian(s) 1 Name: Parent(s) or legal guardian Address: (Number and Street, City or Town, State, Zip Code) Phone: Emergency Contact Cell: 2 Name: Parent(s) or legal guardian Address: (Number and Street, City or Town, State, Zip Code) Phone: Emergency Contact Cell:

EDUCATION DATA Current Grade Point Average (GPA): (On a 4.0 scale) Attach proof of GPA. Your most recent official school transcript is required. High School: Number of years attended List any high schools you have attended. Began Ended Graduated (if applicable) Diploma (If applicable) A B C College: Number of years attended List any college/colleges you have attended. Began Ended Graduated (if applicable) Diploma (If applicable) A B C

List expenses you expect to incur per semester or quarter: (Approximate figures acceptable). A Tuition: $ B Books: $ C Room & Board/Rent: $ D Other expenses: $ List other financial assistance you will receive per semester or quarter: College Financial Aid Contact Name: Phone/E-mail: A Personal: $ B Other Scholarship(s): $ C Grants: $ D Student Loan(s): $ E Other Financial Resources: $ Comments:

EXTRACURRICULAR, PERSONAL, AND VOLUNTEER ACTIVITIES: What are your educational and professional goals and objectives? List any academic honors, awards and/or membership activities while in high school or college: List any community service activities, hobbies, outside interests, and/or extracurricular activities:

APPLICATION CHECKLIST A. The following items must be completed and/or submitted in order for the application to be considered. If you answer no to any of the following, your application will be considered incomplete. B. Your application will not be considered if these items are not attached to this application. (No exceptions.) C. CHECK YES or NO to be sure you have completed or submitted each item as required. YES NO Proof of Citizenship or Permanent US Residency. Copy of Driver s License, US Passport or Alien Registration Card. (This can be scanned and e-mailed or mailed to our office). YES NO Two (2) recommendation forms. Please have those completing the forms mail them in sealed envelopes directly to our office. Names, phone, and e-mail address of those referring you: 1. 2. YES NO I will attend or I am currently enrolled in college. I am currently seeking an undergraduate degree. YES NO Most recent official high school or official college transcript. Photocopies of your transcript are not acceptable. (Please mail this directly to our office.) YES NO Personal Essay. [Insert Topic] (1,500 Character Limit) CERTIFICATION In submitting this application, I certify that the information contained herein is complete and accurate to the best of my knowledge. I understand that I may be required by the Brian Terry Foundation to provide additional documentation to corroborate the above information in order to receive scholarship payments. Falsification of information may result in the termination of any scholarship granted. Applicant s Signature Date