Xi State Scholarship Application Review Form 2014
Xi State Scholarship Committee
Application Review Form
Name of Applicant: ______
Postmark Dates (February 1, 2014, postmark deadline):
______Application Packet (to include original and 5 copies of each component below)
_____ Application Form Complete (6 total copies)
_____ Photo (6 total copies)
_____ Description of Program (6 total copies)
_____ Description of DKG Service (6 total copies)
_____ 3 Letters of Recommendation (6 total copies of each)
Society Letter of Recommendation from ______*
Supervisory Letter of Recommendation from ______**
Scholarly Letter of Recommendation from ______***
______Transcript from ______Cum GPA______
Degree(s) Awarded ______Date ______
Honors received ______
______Transcript from ______Cum GPA______
Degree(s) Awarded ______Date ______
Honors received ______
______Transcript from ______Cum GPA______
Degree(s) Awarded ______Date ______
Honors received ______
______Transcript from ______Cum GPA______
Degree(s) Awarded ______Date ______
Honors received ______
_____ This application is not complete and/or does not meet the required postmark and is therefore not eligible for consideration.
Notes from Chair on communication with applicant, etc.:
ALL Letters of Recommendation must be actual letters. Letters via email will only be accepted if they are scanned and attached as a digital document.
* The society letter of recommendation is to be provided by the current chapter president unless the applicant is the chapter president. In that case, another chapter officer may write the letter on her behalf.
** The supervisory letter is to be provided by a professional associate who has or recently had direct supervision of the applicant.
*** The scholarly letter of recommendation is to be provided by a professor familiar with the applicant’s capacity/performance at the graduate level.
Xi State Scholarship Committee Member
Application Scoring Record
Please score this application based on the rubric associated with each prompt (see #1-8). Total the points accumulated at the end of the ratings (see #9). Identify the Scholarship name and amount you recommend for this applicant to be awarded based on the qualifications required and total score received (see #10).
1. Did the applicant complete the application process completely and promptly?
____ application complete (award up to 2 points)
____ application postmarked on time (award up to 2 points)
2. In the section on the applicant’s program plans, does the applicant demonstrate a clear program plan that shows current enrollment in graduate school, completion plans, and purposeful use of the degree to be earned?
____ program plans describe previous coursework completed (award 2 points)
____ program plans show current enrollment (award 2 points)
____ program plans include plans for completion of degree (award 2 points)
____ program plans describe future use of degree (award 2 points)
3. In the section on DKG service, does the applicant demonstrate a pattern of involvement in and leadership with Delta Kappa Gamma?
____ applicant participates with local chapter (3 points)
____ applicant participates with Xi State (3 points)
____ applicant participates with DKG International (3 points)
____ applicant holds/has held leadership position(s) with local chapter (3 points)
____ applicant holds/has held leadership position(s) with Xi State (3 points)
____ applicant holds/has held leadership position(s) with DKG Intl (3 points)
4. Does the letter of recommendation from the applicant’s chapter president (Society) describe the applicant as a person who exhibits the characteristics of a key woman educator? Is the applicant involved in specific actions to achieve the Society’s purposes? Does the chapter president’s description support the applicant’s description of service? Is the letter signed?
____ letter of recommendation signed by chapter president* (3 points)
____ letter describes applicant as key woman educator (up to 5 points)
____ letter describes applicant as active to achieve Society’s purposes (up to 5 points)
____ letter corresponds with applicant’s description of service (3 points)
5. Does the letter of recommendation from an administrator or supervisor (Supervisory) describe the applicant as a person who exhibits the characteristics of a key woman educator? Does the letter give evidence of an individual who is committed to the educational profession? Does the letter anticipate the applicant using the graduate degree to the benefit of others? Is the letter signed? Is the letter on letterhead?
____ letter of recommendation signed by supervisor (3 points)
____ letter on letterhead of supervisor (3 points)
____ letter describes applicant as key woman educator (up to 5 points)
____ letter gives evidence of applicant as committed to education (up to 5 points)
____ letter anticipates use of degree toward benefit of others (up to 5 points)
6. Does the letter of recommendation from a professor familiar with the applicant’s academic work (Scholarly) describe the applicant as a person who exhibits the characteristics of a key woman educator? Does the letter give evidence of an individual who is committed to personal excellence as a graduate student? Does the letter provide evidence of the applicant successfully completing the graduate degree? Is the letter signed? Is the letter on letterhead?
____ letter of recommendation signed by professor (3 points)
____ letter on letterhead of professor (3 points)
____ letter describes applicant as key woman educator (up to 5 points)
____ letter speaks highly of applicant as a graduate student (up to 5 points)
____ letter anticipates completion of degree (up to 5 points)
7. Does the provided information from transcripts indicate the applicant has a commitment to both success and excellence? Do the listed institutions adequately cover the individual’s educational pursuits as listed on the application form?
____ transcripts demonstrate applicant’s past success/excellence (up to 4 points)
____ transcripts match educational credentials on application form (2 points)
8. List any additional evidence provided in the application not addressed by the above prompts that should weigh positively toward this applicant receiving a scholarship (e.g., awards outside DKG, additional service outside DKG, etc.).
Evidence:
____ (award up to 6 points)
9. What is the applicant’s total score based on your above ratings?
____ TOTAL SCORE (out of a possible 100)
10. For which Xi State Scholarship would you recommend this applicant? Please explain as needed below.
Pursuit of a Doctorate (e.g., EdD, PhD, JD)
_____ The Lois Jones Special Scholarship ($3,000)
_____ Isabel Wheeler ($3,000)
Study Beyond Master’s (e.g., EdS, EdD, PhD, additional certifications/licensures)
_____ Maycie K. Southall ($3,000)
Study Beyond Bachelor’s (e.g., MA, MS, MEd, EdS, EdD, PhD, add cert/lic)
_____ Mary Hall ($3,000)
_____ Evangeline Hartsook ($1250)
_____ Lottye McCall ($1250)
_____ Louise Oakley ($1250)
_____ Eleanor Osteen ($1250)
11. Your signature ______Date ______
p. 1 of 1