Galena Park ISD

Education Foundation

14705 Woodforest Blvd * Houston, Texas 77015

Kenneth Wallace Leadership Scholarship

Application for the 2012-13 School Year

OFFICIAL RULES

In order to be eligible for this scholarship, applicants must complete the application form in its entirety and return it to the North Shore Senior High School counselors’ office by the entry postmark deadline, Friday April 19, 2013. All applicants must:

• Graduate from North Shore Senior High School

• Enroll in a college or university in the Fall of 2013

• Have demonstrated leadership qualities

• Meet minimum graduation requirements

• Mastered all four (4) parts of the TAKS test

• Have a 3.2 or above GPA

The Kenneth Wallace Leadership Scholarship Committee will review all applicants.

Kenneth Wallace Leadership Scholarship

STUDENT APPLICATION

APPLICATION INFORMATION MUST BE TYPEWRITTEN EXCEPT FOR SIGNATURES

If space provided in any section proves inadequate, information may be continued on additional sheets of paper and attached to the application.

APPLICATION DATA

NAME

LAST / FIRST / MIDDLE

STREET ADDRESS

CITY, STATE & ZIP CODE

TELEPHONE NUMBER

DATE OF BIRTH PLACE OF BIRTH

HIGH SCHOOL DATA

Your rank:______in a class of :______students. Cumulative grade point average (4.0 scale)______

LIST SCHOOL ACTIVITIES, ACCOMPLISHMENTS, and/or AWARDS


CONTINUED:

College you plan to attend and your planned major
IN A SHORT ANSWER, DESCRIBE WHY YOU WANT TO PURSUE THE PROGRAM LISTED ABOVE:

LIST COMMUITY AND VOLUNTEER ACTIVITIES

GOALS AND ASPIRATIONS

Write a brief essay (100-200 words) on your goals as they relate to your: 1- Education; 2- Career, and 3- Future Plans – Use additional sheet if necessary.


OTHER EXPERIENCES

In two or three sentences, state which experiences or persons have contributed to your achievements to-date.

PERSONAL INCOME STATEMENT AND WORK EXPERIENCE

ARE YOU CURRENTLY EMPLOYEED /
YES If YES, how many hours per week?______
NO
WILL YOU NEED TO WORK DURING THE FALL AND SPRING SEMESTERS WHILE IN COLLEGE? /
YES If YES, how many hours per week?______
NO
DO YOU OR YOUR FAMILY HAVE ANY SAVINGS FOR COLLEGE? /
YES
NO

APPLICATION CHECKLIST

This application for the scholarship becomes complete and valid only when you have submitted the following materials together in an envelope.

______Student Application

______Essay – Goals and Aspirations attached on separate paper if necessary

Hand deliver to:

Ms. Ann Gustavus

North Shore Senior High School Counselors’ Office

SELECTION OF RECIPIENTS

The Kenneth Wallace Leadership Scholarship Committee has the sole responsibility for selecting the recipient.

CERTIFICATION

In submitting this application, I certify that the information provided is complete and accurate to the best of my knowledge. Falsification of information will result in termination of any scholarship granted. This application becomes the sole property of the Galena Park ISD Education Foundation.

** ALL INFORMATION IS STRICTLY CONFIDENTIAL AND USED ONLY FOR THE PURPOSES OF THIS SCHOLARSHIP

APPLICANT’S SIGNATURE______DATE ______

PARENT’S SIGNATURE______DATE ______