Please Type Or Use Pen

Winston-Salem/Forsyth County Schools

UNCF/College Fund

Scholars Program Scholarship

Please type or use pen

I. GENERAL INFORMATION

Name:____________

Address:______

______

E-mail Address: ______

Telephone Number:______Social Security Number:____________

Age: ______Date of Birth:______Sex: ______Male ______Female

Father or Guardian:______Mother or Guardian:______

Address (if different from yours) Address (if different from yours)

______

Occupation:______Occupation:______

Employer:______Employer:______

Number of Siblings:______Number of Siblings in College:______

High School:______

II. COLLEGE INFORMATION

School to which you have applied/will be applying:

1st Choice:______

2nd Choice:______

3rd Choice:______

Status of Your Applicaton

1st Choice:______Accepted ______Pending ______Have Not Heard Yet

2nd Choice:______Accepted ______Pending ______Have Not Heard Yet

3rd Choice:______Accepted ______Pending ______Have Not Heard Yet

Deadline: Friday, May 18, 2012

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Winston-Salem/Forsyth County Schools

UNCF/College Fund

Scholars Program Scholarship

III. BACKGROUND INFORMATION

Please attach a transcript showing grades through the end of the seventh semester

1-Grade point average is ______out of a possible 4.0 (through the end of the 7th semester)

2-Class rank ______weighted among a class of ______students

Class rank ______non-weightedamong a class of ______students

3-SAT or ACT Scores

Date taken:______SATM______V______ACT Composite Score______

4-Describe your leadership roles in school and community:

______

5-Describe any community service volunteer work or experiences you have had in helping other people:

______

6-Describe any part-time or summer work experience:

______

7- Additional comments: (if more space is needed use back of page)

______

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Winston-Salem/Forsyth County Schools

UNCF/College Fund

Scholars Program Scholarship

IV. ESSAY In the space provided below, please write an essay for the following question:

How can you as a teacher (or otherwise) make a positive contribution to society?

______

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Winston-Salem/Forsyth County Schools

UNCF/College Fund

Scholars Program Scholarship

V. TEACHER RECOMMENDATION FORM

Applicant’s Name:______

This student has applied for the Winston-Salem/Forsyth County Public Schools The College Fund/UNCF Scholars Program Scholarship to be awarded to a graduating senior. Please complete the following, using specific examples where possible.

Please type or use pen.

1-How long have you known the applicant and in what capacity?

2-Why do you believe the applicant will be successful pursuing a degree in education or another field?

3-What is your assessment of the student’s academic ability?

4-Please rank the applicant according to the following scale:

Superior Excellent Good Fair Not Observed

Scholastic Ability

Civic responsibility & concern

Creative thoughts/communication skills

Academic dedication & seriousness of purpose

Leadership

5-Additional comments: (if more space is needed, use back of page)

Name:______Position/Title:______

Signature:______Date:______

RETURN THIS FORM IN A SEALED ENVELOPE

DIRECTLY TO Student Services attn: Kenneth Simington by Friday, May 18, 2012

page 4

Winston-Salem/Forsyth County Schools

UNCF/College Fund

Scholars Program Scholarship

V. TEACHER RECOMMENDATION FORM

Applicant’s Name:______

Please type or use pen.

1-How long have you known the applicant and in what capacity?

2-Why do you believe the applicant will be successful pursuing a degree in education or another field?

3-What is your assessment of the student’s academic ability?

4-Please rank the applicant according to the following scale:

Superior Excellent Good Fair Not Observed

Scholastic Ability

Civic responsibility & concern

Creative thoughts/communication skills

Academic dedication & seriousness of purpose

Leadership

5-Additional comments: (if more space is needed, use back of page)

Name:______Position/Title:______

Signature:______Date:______

RETURN THIS FORM IN A SEALED ENVELOPE

DIRECTLY TO Student Services attn: Kenneth Simington by Friday, May 18, 2012

page 5

Winston-Salem/Forsyth County Schools

UNCF/College Fund

Scholars Program Scholarship

VI. PARENT/GUARDIAN STATEMENT

1-Describe your financial need and how a scholarship would be helpful funding your child’s education.

______

2-Explain any circumstances which have been a significant demand upon your family’s budget.

______

3-Describe your support for your child’s interest in the field of education or another career. Please explain.

______

4-What is the total combined income of your household?

0 - $14, 999$45,000 - 59, 999

$15,000 - 29,999$60,000 or over

$30,000 - 44,999

Deadline: Friday, May 18, 2012

page 6

Winston-Salem/Forsyth County Schools

UNCF/College Fund

Scholars Program Scholarship

STATEMENT OF AGREEMENT

I certify that the information represented in this application is true and fairly represented to the best of my knowledge. I further certify that if I am chosen as the recipient for the Winston-Salem/Forsyth County Public Schools/College Fund-UNCF Scholars Program Scholarship, I will agree to the conditions set forth in the scholarship requirements.

To maintain continued scholarship eligibility, I will maintain a 2.5 grade point average or higher in my college course work, provide annual proof of academic eligibility with an official transcript, and make satisfactory progress towards a degree.

If at any time I no longer meet the requirements for the scholarship, I understand that I forfeit any future benefits from the scholarship.

Applicant Signature______Date______

Parent/Guardian______Date______

Signature

Return with UNCF Application

Deadline: Friday, May 18, 2012

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SCHOLARSHIP APPLICATION CHECKLIST

______Application completed - pages 1 & 2

______Transcript requested (through end of 7th semester)

______Personnal statements completed - page 3

______2 teacher recommendation forms collected in sealed envelopes - pages 4 & 5

______Parent/Guardian statement completed - page 6

______Signed statement of agreement - page 7

ALL THE ABOVE MATERIALS SHOULD BE RETURNED TO Student Services attn: Kenneth Simington by Friday, May 18, 2012