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 / MIDDLESTREET 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:
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 ______