Green Mountain College Make A Difference Scholarship Application Thank you for your interest in the Green Mountain College Make A Difference Scholarship. Green Mountain College will be accepting applications until February 15th. There is no fee for this application. This application is for Green Mountain College s Make A Difference Scholarship. Students will be notified of their acceptance to Green Mountain College on a rolling basis, as their applications for admission are completed. Finalists for the Green Mountain College Make A Difference Scholarship will be asked to complete a phone or online Skype interview on selected dates. Winners will be awarded a full tuition scholarship for four years at GMC. APPLICATION REQUIREMENTS: First-time Freshmen: Transfer Students: Official High School Transcript SAT or ACT scores 3 Letters of Recommendation (Including one from a high school teacher, counselor, or principal and one from a local community member.) Essay Interview (Scholarship Finalists only) Official College Transcript(s) Official High School Transcript SAT or ACT scores (only if less than 24 transferable college credits) 3 Letters of Recommendation (Including one from a professor, counselor, or administrator and one from a local community member.) Essay Interview (Scholarship Finalists only) International Students: Official Transcripts (College and/or High School) SAT or TOEFL Scores (Including one from a high school teacher, counselor, or principal and one from a local community member.) Essay Interview (Scholarship Finalists only) For all applicants please supply any articles or other portfolio information that would help the committee. GREEN MOUNTAIN COLLEGE CODES SAT: 3418 TOEFL: 3418 ACT: 4302 FAFSA: 003687 PROFILE: 3418 All application materials should be sent to: Green Mountain College Make A Difference Scholarship Committee Office of Admissions 1 Brennan Circle Poultney, VT 05764 If you have any questions or need additional information, please call (802) 287-8000 or (800) 776-6675; or fax to (802) 287-8099; or e-mail admissions@greenmtn.edu
PERSONAL DATA (please print or type) Legal Name: SSN: Last/Family First Middle (complete) Prefer to be called: Former last name(s) if any: Applying as a : apple Freshman For: apple Full-Time Study Living: apple Residence Hall Gender: apple Male apple Transfer apple Part-Time Study apple Commuter apple Female For the term of : apple Fall apple Spring Year: Permanent Address: Number and Street City State Zip Country If different from above, please give your mailing address for all admission correspondence: Mailing Address: Number and Street City State Zip Country Phone at Permanent Address: Phone at Mailing Address: (Including Area Code) (Including Area Code) E-Mail Address: Birthdate: Month/Day/Year Citizenship: apple U.S./dual U.S. citizen If dual, specify other citizenship: apple U.S. Permanent Resident visa Citizen of: apple Other citizenship If you are not a U.S. Citizen and live in the United States, how long have you been in the country? Possible area(s) of academic concentration/major: apple Or undecided: Will you be a candidate for financial aid? apple Yes apple No If yes, the appropriate form(s) will be filed on:
Month/Day/Year The following items are optional: Place of Birth: City State Country First Language, if other than English: Marital Status: Language Spoken at Home: If you wish to be identified with a particular ethnic group, please check the following: apple African American, Black apple Native Hawaiian, Pacific Islander apple American Indian, Alaskan Native (tribal affiliation enrolled ) apple Puerto Rican apple Asian American (country of family s original origin ) apple White or Caucasian apple Asian (Indian Subcontinent country ) apple Hispanic, Latino (country ) Other (Specify ) Mexican American, Chicano EDUCATIONAL DATA Freshman/Transfer Candidates: Current High School: Dates of attendance: Address: College Counselor Name: City State Zip Date of High School graduation: Is your school: apple Public apple Private apple Parochial Transfer Candidates: Current College: Dates of attendance: Address: City State Zip Degree Candidate: List of all high schools/colleges attended: Name Location (city, state, zip) Degree Candidate? Dates Attended Test Data: SAT I : Date Verbal Math Date Verbal Math ACT: Date English Math Reading Science Composite Test of English as a Foreign Language (TOEFL) : Date Score
FAMILY INFORMATION Mother s full name: Father s full name: Is she living? Is he living? Home Address, if different than yours: Street: Home Address, if different than yours: Street: City State Zip City State Zip Occupation: Name of Business/Organization: Work Phone: College (if any): Occupation: Name of Business/Organization: Work Phone: College (if any): Degree: Year: Degree: Year: Professional or Graduate School (if any): Professional or Graduate School (if any): Degree: Year: Degree: Year: If not with both parents, with whom do you make your permanent home: Please check if parents are: apple Married apple Separated apple Divorced (date ) apple Other Please give the names and ages of your brother and sisters. If they have attended college, give the names of the institutions attended, degrees, and approximate dates: Name Age Institution Degree Dates Attended GREEN MOUNTAIN COLLEGE MAKE A DIFFERENCE SCHOLARSHIP In a sentence or two, please describe what you did to make a difference.
ACADEMIC HONORS Briefly describe any scholastic distinctions or honors you have won: EXTRACURRICULAR ACTIVITIES On a separate sheet of paper please list your principal extracurricular, community, and family activities and hobbies in the order of their interest to you. Include specific events and/or major accomplishments such as musical instrument played, varsity letters earned, etc. WORK EXPERIENCE List any job (including summer employment) you have held during the past three years. Specific nature of work Employer Approximate dates of employment Hours per week In the space provided below, or on a separate sheet if necessary, please describe which of these activities (extracurricular and personal activities or work experience) has had the most meaning for you, and why. PERSONAL STATEMENT Please write two essays (as long or as short as you think is necessary). Choose two from the following topics. 1. Please explain what you believe to be the most significant aspect of your actions and why. 2. Please explain what inspired your actions. 3. Please discuss the feedback you have received since your involvement. 4. Please discuss what you believe was the greatest obstacle to your achievement and how did you overcome it. 5. If you could choose one individual on whom to impart the lessons you ve learned from this experience, who would it be and what would you tell them about your actions and experiences? REFERENCES Please list three people who will be providing references for your Make A Difference Scholarship application. 1. 2. 3.
I understand this application must be complete (transcript, 3 letters of recommendation, standardized examination scores, and personal statement) before any consideration can be given for the Make A Difference Scholarship. The undersigned agrees that the information furnished on this Application for Admission form, together with all information received by the Make A Difference Scholarship Committee as a result of this application from whatever source, shall be completely confidential and shall not be disclosed to anyone, including the candidate and their family, except that the Dean of Enrollment and Retention Management may, in his sole and uncontrolled discretion, disclose any part or all thereof to such a person as he deems available. Green Mountain College subscribes fully to all federal and state legislation and regulations (including the 1964 Civil Rights Act, Executive Order 11246, Title IX of the Educational Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, Americans with Disabilities Act, and the IRS Anti-Bias regulation) regarding discrimination on the basis of race, color, gender, religion, age, disability, sexual orientation, or national or ethnic origin in its programs and activities. In accordance with Vermont Statues Annotated, Title 16, Statue 176, Section 1 (c ) (1) (C ), all colleges and universities in Vermont are required to inform candidates that credits earned at their respective institutions are transferable to other programs only at the discretion of the receiving school. Your signature below indicates that all information in your application is complete, factually correct, and honestly presented. Signature of Applicant: Date: