Cincinnati Chapter of PFLAG

P.O. Box 19634 – Cincinnati, Ohio 45219

www.pflagcinci.org - Website

- Email

2017 Scholarship Application

:: Applicant Information ::

Please provide information where you may be reached for questions or notification.

Name: ______

Address: ______

City: ______State: ______Zip: ______

Phone: ______Birth Date: ______Gender: ______

Email Address: ______

:: Requirements ::

Applicants must: (a) Be a resident of or attending college in the Greater Cincinnati area, (b) Be a student (at least 17 years-old as of April 14, 2017), (c) Demonstrate positive involvement with the LGBT community, and (d) Cannot be a prior winner of this award.

Applications will be considered only if the following are postmarked by April 14, 2017:

□ Completed scholarship application and this cover sheet with personal signature

□ Your high school or GED transcript (sent by your school) and/or

□ Your most recent college or university transcripts (if applicable)

□ Two letters of recommendation that can speak to your LGBT involvement,

academic success and your character.

The scholarships are a reflection of our community’s commitment to academic excellence and public service. Past recipients have worked to make the world a better place for the LGBT community. Scholarships are awarded based upon a demonstrated genuine interest in learning, strong academic achievement, success in extracurricular activities, and leadership.

 PFLAG 2017 Scholarship Application 

Please type or print your responses (Typing is encouraged). Please attach additional pages if necessary.

Applicant Name: ______

:: College / University Information ::

Please list the name of the school(s) where you have applied or currently attend.

:: Work Experience, Clubs & Organizations ::

Please list work experiences, school organizations and volunteer activities in which

you have participated including any LGBT organizations. Include any leadership

positions that you have held.

:: Personal Information ::

Please list your interests, hobbies, or extracurricular activities. Be sure to include

any LGBT involvement. Choose one and explain why that particular activity

has made a significant impact on your life.

:: Academics ::

How accurately does your academic record reflect your intellectual ability?

Please elaborate.

:: Career Plans ::

Please describe how your intended college major relates to your career plans.

If you are unsure about your major, please explain how a college experience will

benefit you in the future.

:: Achievements ::

What achievement, accomplishment or contribution to the LGBT community has made you especially proud? Please explain.

:: Quality of Life ::

Please select one of the following questions to answer.

How has being gay, lesbian, transgender or intersex affected your life?

How has being a straight supporter affected your life?

:: Personal Statement ::

Please submit a personal statement of any kind to help the Scholarship Committee

better understand the individual applying for a PFLAG Scholarship.

While PFLAG guards the confidentiality of all applicant information, our organization cannot guarantee complete anonymity. All applicants will be notified of the results at the address or phone number indicated on the application. Recipients will be announced at a PFLAG meeting, and names and information from applications may be used in related publicity. Please consider this recognition and whether it will affect your application in any way. PFLAG wishes to honor your achievements but not violate your privacy or confidences.

Agreement:

I certify that the information in my application is correct to the best of my knowledge and that I have read the above statement.

Signature: ______

Date: ______

Scholarship materials should be mailed to the following address:

PFLAG / Scholarship Committee

P.O. Box 19634

Cincinnati, Ohio 45219-0634

Questions?

Please call 513.284.6485 or e-mail

Note: Decisions will be made by a selection committee. All applicants will be notified as soon as possible following the application deadline. Recipients will be honored Tuesday, June 13, 2017 at a meeting of the PFLAG chapter. Details will follow notification of recipients. Scholarship checks will be sent directly to the college or university.