APPLICATION CHECKLIST FOR AFCEA SCHOLARSHIP SUBMISSION

(Submission of this page is not required)

1.Nomination Form (2 pages)

2.Grade Transcripts

3.Essay (200-250 Words)

4.Financial Need Form

Submission e-mailed or mailed on (date): ______

Preferably e-mail to:

Or mail to:

Russ Fellers

AFCEA VP for Education

Attn: Scholarship Award Committee

PO Box 76960

Colorado Springs, CO 80970

Applications must be e-mailed or postmarked no later than 19April 2017 to be eligible for consideration

AFCEA Scholarship Checklist

NOMINATION FORM FOR AFCEA SCHOLARSHIP

Applicant’s Name:

Home Address:

Telephone:

Email Address: ______

High School:

College(s):

Planned Field of Study:

Applicable fields of study include: computer science, electrical engineering, software engineering, information technology (IT), math, physics, or a related field of study within Information Technology.

Parent Member of AFCEA? YES NO AFCEA Member Number

(Membership in AFCEA is NOT required to be eligible for the scholarship)

ACHIEVEMENTS

List Scholastic Awards (National, Regional, or Local) (use additional sheet if required)

Award Description (type and content) / Presented By / Year

AFCEA Scholarship Attachment 1-1

NOMINATION FORM FOR AFCEA SCHOLARSHIP

List Other Awards/Recognition: Athletics, Civil/Community Service, Boy/Girl Scouts, etc., (use additional sheet if required)

Award/Recognition / Presented By / Year

List Extra-Curricular Activities: Music, Drama, Athletics, Debating, Publications, Student Government and Committees, Clubs and Societies, ROTC, etc. (Use additional sheet if required).

Organization / Offices Held / From (mo/yr) / To (mo/yr)

Are there other noteworthy achievements not covered above which you desire to add?

PRIVACY ACT STATEMENT: Under authority of U.S. Title 10, Section 3012, the personal information requested herein (including attached financial need forms and personnel reference statement(s) is to evaluate student’s application for scholarship. The information will be maintained by the Rocky Mountain Chapter, AFCEA Education Fund for administrative use and released only to the individuals needed to evaluate the application. The disclosure of the information is voluntary; however, failure to disclose all or part of the requested information may hinder evaluation of the applications.

I agree to accept decision of the Scholarship Committee Selection Panel’s choice of scholarship award winners. Further, I have read and understand the privacy act statement above.

Signature of Applicant

Email of Applicant

AFCEA Scholarship Attachment 1-2

GRADE TRANSCRIPTS

SCHOLASTIC STANDING

(To be completed and signed by Counselor)

Class Standing: Upper ______% of total class. Number of students in class ______

GPA (use numerical and indicate basis, i.e., 4.0 or 5.0 system)

SAT: / Math / Verbal / ACT:

Has the student indicated a desire to continue his/her education in one of the fields indicated for this scholarship? YES NO

Name of Counselor

Signature of Counselor

PLEASE INCLUDE A COPY OF THE STUDENT’S GRADE TRANSCRIPTS

AFCEA Scholarship Attachment 2

ESSAY

ESSAY:Provide a 200-250 words essay describing how continued education will allow you to meet your career objectives.

Name of Applicant (Printed)Signature of Applicant

AFCEA Scholarship Attachment 3

FINANCIAL NEED FORM

One of the criteria evaluated by the Scholarship Award Committee is financial need. The Applicant needs to provide evidence of the need for financial assistance in pursuing his/her college education.

1.Applicant’s Name:______

2.Family’s Yearly Income:______

3.Other Family Dependents:

Name / Age / School or College

4.A brief statement, written by applicant, on his/her financial need (use reverse side of form if additional space is needed).

Parent’s or Guardian’s Name (Printed)

Parent’s or Guardian’s Name (Signature)

Parent’s or Guardian’s Telephone ______

Parent’s or Guardian’s Email Address _______

AFCEA Scholarship Attachment 4