WILLIAM RANDOLPH HEARST SENATE YOUTH PROGRAM
Applicant’s Name:
School:
I certify that all information on this application form is accurate to the best of my knowledge.
Student’s Signature
Date
Principal’s Signature
(Recommendation by Principal Required)
Deadline for Application:
Must be sent by one of the following options:
Postmarked/Emailed/Faxed/Online Submission to the VPA by October 11, 2013
Note: Please include current email address for prompt
email confirmation to be sent upon receipt of completed application.
Note: Please include current email address for prompt
email confirmation to be sent upon receipt of completed application.
Vermont Principals’ Association
2 Prospect Street, Suite #3
Montpelier, VT 05602
Fax# 1-802-229-4801
Email: mailto:
STUDENT PROFILE
APPLICANT’S NAME:
DATE OF APPLICATION:GRADE LEVEL: (11th or 12th)
HIGH SCHOOL: PHONE:
*NAME OF PARENT OR GUARDIAN:
*NAME OF PARENT OR GUARDIAN:
* PARENT/GUARDIAN WORK PHONE:
* PARENT/GUARDIAN WORK PHONE:
*HOME ADDRESS:*PHONE:
*CITY, STATE, ZIP:
*STUDENT E-MAIL ADDRESS:
* STUDENT CELL PHONE:
DATE OF BIRTH:PLACE OF BIRTH:
ACADEMIC INFORMATION
RANK IN CLASS:STUDENT RANKS IN CLASS OF STUDENTS
APTITUDE:PSAT:SAT:OTHER:
NOTICE
*A COPY OF ACADEMIC TRANSCRIPTS INCLUDING CURRENT YEARS SCHEDULE, STUDENT RANK IN CLASS AND TEST INFORMATION MUST B E ACCOMPANIED BY SUPPORTING DOCUMENTATION
CURRENT ELECTIVE OFFICE
*UNDERLINE THE FOLLOWING OFFICE THAT YOU CURRENTLY HOLD:
CLASS:PRESIDENT VICE-PRESIDENT SECRETARY TREASURER
STUDENT BODY: PRESIDENT VICE-PRESIDENT SECRETARY TREASURER
STUDENT COUNCIL REPRESENTATIVE
*REQUIRED INFORMATION
HOW TO QUALIFY
Two students from each state and the District of Columbia, and a first and second alternate from each state and the District of Columbia, will be selected by the office of the Commissioner of Education.
Selection will be based solely on outstanding ability and demonstrated qualities of leadership as elected high school student body officers of the current school year.
1.Any high school junior or senior student (irrespective of race, color, creed, sex or financial need) is eligible for the program provided he or she has not previously been a delegate to the program, and is currently serving in an ELECTED capacity in any one of the following student government offices:
A.STUDENT BODY PRESIDENT, VICE-PRESIDENT, SECRETARY OR TREASURER
B.CLASS PRESIDENT, VICE-PRESIDENT, SECRETARY OR TREASURER
C.STUDENT COUNCIL REPRESENTATIVE
D.STUDENT REPRESENTATIVE ELECTED OR SELECTED (selected by a panel, commission or board) to district, regional or state level civic or educational organization.
- Each student must be a PERMANENT RESIDENT of the United States and currently enrolled in a public or private secondary school located in the state including for these purposes the District of Columbia in which either one of his or her parents or guardians legally resides. A student attending a school which is located in a state other than the state legal residence of either one of such student’s parents or guardians is not eligible.
PROCESS
1.A MAXIMUM of two students will be nominated by the principal of each school.
2.Each candidate will be a member of the junior or senior high school class who qualifies based on the program’s “how to qualify” statement.
3.Finalists will be asked to attend a formal interview.
4.Winners will be announced by our United States’ Senators in early December.
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IMPORTANT
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TO:THE STUDENTS
FROM: WILLIAM RANDOLPH HEARST COMMITTEE
RE:APPLICATION PACKET
In order for your application to be considered, the following must be included:
1.Completed Student Profile Form (Including application, cover page with principal’s signature)
2.Completed Student Response Form
3.Attached copies of academic transcripts
4.THREEletters of recommendation **(ONE OF THESE MUST BE FROM YOUR SCHOOL PRINCIPAL) **
5.Student Rank in Class MUST BE STATED with documentation attached.
6.List of school activities: inclusive of grades 9-12
7.List of community activities
8.List of your hobbies and interests.
(Profile, Response Forms, Letters of Recommendations and Supporting Documentation) (Only fully completed applications will be considered by the William Randolph Hearst Senate Youth Scholarship Committee. See Hearst Checklist)
Deadline for Application:
Must be sent by one of the following options:
Postmarked/Emailed/Faxed/Online Submission to the VPA by October 11, 2013
Note: Please include current email address for prompt
email confirmation to be sent upon receipt of completed application.
Note: Please include current email address for prompt
email confirmation to be sent upon receipt of completed application.
Vermont Principals’ Association
2 Prospect Street, Suite #3
Montpelier, VT 05602
Fax# 1-802-229-4801
Email: mailto:
STUDENT RESPONSE FORM
(Word Count limit: 50 words, 12pt font, Times Roman)
- What do you feel are the important qualities of good leadership?
2.Briefly describe, by example, your “demonstrated qualities of leadership as they
pertain to your current elective school office.
3.Briefly describe, by example, any community-related activities that demonstrate your leadership abilities.
4. To what do you owe your success as a leader?
5. What role have your present leadership skills played in determining your future
plans and aspirations?
6. If you could spend a day with a national or world leader, who would you choose,
and why?
7. If you had the opportunity to make one significant change in government, what
would that change be, and why?
REQUIRED ESSAY QUESTION
- Essay response requirements: WORD COUNT : 600, SINGLE SPACED, 12PT FONT, TIMES ROMAN
Please place your name and school name in the top right hand corner of the page.
ESSAY QUESTION
“and so, my fellow Americans, ask not what your
country can do for you; ask what you can do
for your country.”
President John Fitzgerald Kennedy
The race between education and erosion, between wisdom and waste has not
run its’ course ......
The nation’s battle to preserve the common estate is far from won . . . The
crisis may be quiet but it is urgent.
President John F. Kennedy, introduction to The Quiet Crisis
These words were spoken nearly four decades ago by a world leader with great vision for the future. How do these words speak to you today? Imagine that you have been elected as Vermont’s lone Representative in the U.S. Congress. Prepare a speech that would inspire Congressional action using one of these quotations from President Kennedy in the context of your speech.
HEARST SCHOLARSHIP CHECKLIST
A completed application must include:
1. A completed profile page
2. A completed title page including the Principal’s signature
3. A copy of a transcript.
4. Three letters of reference, one of which must be from the
Principal.
______5. List of activities
______6. Completed Short Answer Questions & Essay Question
Note: Any incomplete (missing any of the above checklist information) applications will be disqualified.
Deadline for Application:
Must be sent by one of the following options:
Postmarked/Emailed/Faxed/Online Submission to the VPA by October 11, 2013
Note: Please include current email address for prompt
email confirmation to be sent upon receipt of completed application.
Note: Please include current email address for prompt
email confirmation to be sent upon receipt of completed application.
Vermont Principals’ Association
2 Prospect Street, Suite #3
Montpelier, VT 05602
Fax# 1-802-229-4801
Email: mailto:
The Hearst Scholarship Process Timeline
Oct. Applications received & confirmation sent via email
Oct. Applications sent to Committee
Oct. Committee meets to select/notify candidates
Nov. Not selected applicant letters are sent out
Nov. Interviews for selected candidates & delegates chosen