Kevin Michael Niles Scholarship

Application for the 2009-2010 Academic Year

Application and all supporting documentation must be RECEIVED by the Niles Family no later than July 1, 2009.

Name in Full (Please print or type. Do not use initials or abbreviations.):

______

□ Male □ Female

Current Mailing Address (valid through ______):

(Date)

______

Number and Street

______

City State Zip Code

Permanent Mailing Address:

______

Number and Street

______

City State Zip Code

Telephone:

______

Current Permanent Fax

E-mail: ______

I am currently registered with BSA as ______with the ______Council.

(position) (name of council)

Social Security Number: ______Date of Birth: ______

MonthDayYear

Summer Camp Staff Experience
Year / Camp / Position
Honors

What academic honors have you received? (if any)

______

______

______

Please list any leadership experience.

______

______

______

Please list your scouting experience.

______

______

______

Are you an Eagle Scout? ______If yes, what year did you earn it? ______

Are you a GSA Gold Award Recipient? ______If yes, what year did you earn it? ______

High School Information

I attend/attended ______High School.

GPA: Cumulative GPA of ____ on a scale of ______Adjusted GPA on a 4.0 scale _____

Current Class Rank ______out of ______students

□ I am currently a Senior.

□ I have graduated from high school.

Test ScoresACT Test Score ______SAT Test Score ______

GED Information (if applicable): ______

______

______

College Information

I am currently attending ______

Majoring in ______with a GPA of ______

Expected Graduation Date ______

Future Plans:

Possible College Majors: ______

Possible Career Interest(s): ______

If you are still in high school, list the colleges to which you are applying. Indicate application status as Pending, Accepted, Waiting List or Other.

______

College Status College Status

______

College Status College Status

______

College Status College Status
Short Answer Questions And Essay

Short Answer Questions: The Selection Committee would like short answers to the following questions. Complete your answers using the space provided. Your answers will also enable us to assess your writing ability.

Applicant Name: ______

Last First

  1. What does “your character is your destiny” mean to you personally?

______

  1. What scouting values are important to you and how do they apply to your daily life?

______

Essay: Please write an essay on the topic of “WhyCollege is Important to me.” Your essay should be typed on a separate single sheet of paper, on one side only. Clearly label the top of the page with your name. Title your essay. Do NOT exceed 250 words. This essay, along with the rest of your application must be received no later than July 1, 2009.

Recommendation Form for the Kevin Michael Niles Scholarship Award

How well do you know this □Very Well□Reasonably Well□Somewhat

applicant?

Length of time have you known the applicant and in what capacity: ______

In one sentence, characterize the applicant? ______

______

What are the first three adjectives that come mind in describing this applicant?

  1. ______2. ______3. ______

Do you have any reservations about recommending this student? If so, explain.

______

Ratings: How would you rate this applicant in the following areas?

Below
Average / Average / Good / Very
Good / Excellent
Dedication/Commitment to Task
Community/Volunteer Involvement
Character
Potential for Future Leadership/Service
Overall Recommendation

______

Name of Person Completing This Form Title/Position

______

TelephoneE-Mail

______

Signature Date

Please Mail : The Kevin Michael Niles Scholarship, P.O. Box 1261, Pacific Palisades, California90272 Fax (310) 459-7193 by July 1, 2009.