Scholarship Application March 2018

(Please type your answers)

Interested applications should complete the attached application, along with any attachments required, on or before February 23, 2018 by 4:00 p.m. There is no established application fee.

Late or incomplete applications are not accepted and will not be considered. The scholarship winner will be announced in March 20, 2018. An Officer of the Foundation will provide the scholarship certificate to the recipient. Any scholarship money will be provided directly to the college and/or university directly, after all stipulations have been satisfactorily met in accordance with these Scholarship Guidelines.

Mail one original copy of a completed typed application package to:

The Chiyo Watanabe Miles Memorial Scholarship Foundation

c/o Scholarship Committee

P.O. Box 128

Parker, CO 80134

(This includes application with signoff by Guidance Department, essay, resume, and official school transcript)

Last Name: / First Name:
Mailing Address
Street:
City: / State: / Zip Code:
Daytime Telephone Number:
E-mail Address:
Date of Birth and Gender:
Month: / Date: / Year: / Gender:
Cumulative Grade Point Average (GPA) (on a 4.0 Scale):
Attach proof of GPA. Your most recent Official School Transcript is required.
Are you the first person in your family to go to college? Yes: No
Attach your current resume; however, you still must answer the following questions:
  1. List any academic honors, awards, and membership activities while in high school:

  1. List your hobbies, outside interests, extracurricular activities and school related volunteer activities:

  1. List your non-school sponsored volunteer activities in the community:

If you have decided on what college you will attend, please list the school name:
If not, list your top 3 college choices:
1.
2.
3.
List your Family Total Annual Income from your 2016 or 2017 Income Tax Form 1040 Line #22:
$
(If selected, recipients may be asked to verify annual household income is under $75,000 by supplying page 1 of their household Federal 2016 or 2017 Income Tax Form).
Name and address of parent(s) or legal guardian(s). Include address if different than your own listed in Question 2.
Name(s):
Street Address:
City: / State: / Zip Code:
Home Phone Number of Parents or Legal Guardians:
Work name, location, and address of Parent or Legal Guardian:
Work Phone Number of Parents or Legal Guardians:

In the space provided below, please write an essay (1,000 – 2,000 words) answering the following questions:

  1. We talked about the character of Chiyo Watanabe Miles in our Foundation overview. In your own words, compare and contrast your definition of Chiyo’s defining character to that of your personal character.
  1. We mentioned Chiyo left a legacy of good will; the Purpose of our Foundation is, in part, to award a scholarship to a student with a proven record of helping others within his/her own community. In your own words:
  1. list and define the legacy of good will Chiyo left behind;
  2. describe how volunteer or community service has shaped who you are today; and,
  3. define what community service has taught you.
  1. Chiyo had to face many challenges in her life time. Discuss what challenges and/or obstacles you have experienced and overcome in your life and how this will help you succeed in college and beyond.
  1. Why do you feel you are deserving of this scholarship award?
  1. The Foundation has a specific Mission Statement. In your own words:
  1. what are your career goals and aspirations;
  2. once your goals and aspirations are realized, how do you plan to “pay it forward?”

STATEMENT OF ACCURACY FOR STUDENTS

I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. I also consent that if chosen as a scholarship winner my picture may be taken and used to promote the Foundation’s scholarship program.

I hereby understand that if chosen as a scholarship winner, I must be present at any potential awards ceremony, surprise, or reception in March 2018 to receive my scholarship award.

I hereby understand that if chosen as a scholarship winner, according to the Foundation Scholarship Guidelines, it is my responsibility to remit to the Foundation the appropriate information for my scholarship to be paid directly to my educational institution.

I hereby understand I will not submit this application without all required attachments and supporting information. I understand that incomplete applications or applications that do not meet eligibility criteria will not be considered for this scholarship.

Signature of Scholarship ApplicantDate

STATEMENT OF SUPPORT BY GUIDANCE COUNSELOR

I hereby affirm that this application meets the criteria set forth by this scholarship program and that I support this application to the Foundation.

Print Name of Guidance Counselor Submitting the Application

Signature of Guidance Counselor Submitting the ApplicationDate

Contact Information (E-mail)Phone Number

Checklist

___ Application

___ Essay

___ Resume

___ Guidance Counselor’s Signature

___ School Transcript

MAIL COMPLETE APPLICATION PACKAGE TO THE FOUNDATION AT:

The Chiyo Watanabe Miles Memorial Scholarship Foundation

c/o Scholarship Committee

P.O. Box 128

Parker, CO 80134

REMINDER:

The deadline for this application to be received by the Foundation’s Office is:

FEBRUARY23, 2018, 4:00 p.m. NO EXCEPTIONS!

1

As of January 10, 2018