JAKE FLYNN MEMORIAL SCHOLARSHIP
1 - $5000 Award – Lakeville South
1 - $5000 Award – Lakeville North
STUDENT INTERVIEW for finalistsTBD
Applications due by 3pm on March 17
Student Name (print): ______
Telephone______Email______
Student’s Dean (print): ______
Jake Flynn was an outstanding student athlete who attended Lakeville South High School. He excelled both academically and athletically. This memorial scholarship has been established in his honor with an annual award given to one Lakeville South and one Lakeville North Student Athlete.
Eligibility and Evaluation Criteria
Student Athlete: Applicant must be an active participant in a high school athletic program.
Strong Academic Record: Applicant must have completed their junior year of high school with a B average or better in college preparatory courses.
Demonstrated financial need: Applicant must have a need for financial assistance.
Outstanding character: Applicant must be outstanding in character, integrity and leadership.
Application Sections
Section1 Certification & Signatures…page 2
Section2 Education & Career Information…page 2
Section 3 HighSchool Transcript for Scholarships(ACT/SAT scores)…page 2 (Automatically requested)
Section 4 Personal Essay...page 2
Section 5 High School Evaluation Form…page 3
Section 1 Certification and Signatures
All of the information on this form is true and completed to the best of my (our)knowledge. We agree to give proof of the information we provided on this application. If selected, my name may be included in anylocal scholarship publicity releases.
Applicant’s Signature:______
Parent/Guardian Signature: ______
Section 2 Education and Career Information
Elementary School(s):______
Middle School(s): ______
Senior High School(s):______
Athletic Participation:______
College or University Intentions
Intended Program of study/major: ______
College attending(if known): ______
1st Choice: ______
2nd Choice: ______
Section3 Scholarship Transcript Request
Applicant’s Official Transcript (with ACT/SAT scores) will automatically be printed and attached to this application.
Took the ACT? ____ No ____ Yes Took the SAT? ____ No ____Yes
Date taken: ______Score: ______Date taken: ______Score: ______
Section 4 Personal Essay
Please prepare, in your own words, a typed essay which will enable the Scholarship Committee to become better acquainted with you. Your essay should include personal background, high school accomplishments, non-school activities and accomplishments, future goals, and what you expect from a college education. Please include why you should be considered for the Jake Flynn Scholarship and what it would mean to you if received.
Section 5High School Evaluation Form
Have High School Faculty member complete the attached form and submit prior to March 18th, 2016.
2017 Jake Flynn Memorial Scholarship
HIGH SCHOOL EVALUATION
(Confidential)
Applicant’s Name____________
First Middle Last
Home Address ______
Street City State Zip code
Lakeville High School NORTH / SOUTH circle one
This section should be completed by a high school teacher or person designated by the principal or dean. All responses will be kept confidential. Please complete and send / email to Jake Flynn Scholarship committee at
Rate the applicant’s conduct and appearance:
___ Superior ___ Excellent ___ Good ___ Average ___ Poor
Rate the applicant’s character and reputation for integrity:
___ Superior ___ Excellent ___ Good ___ Average ___ Poor
Rate the applicant’s ability to define and achieve goals and objectives:
___ Superior ___ Excellent ___ Good ___ Average ___ Poor
Rate the applicant’s overall contribution to the school:
___ Superior ___ Excellent ___ Good ___ Average ___ Poor
Please estimate the applicant’s academic performance at the college level:
___ Superior ___ Excellent ___ Good ___ Average ___ Poor
In summary, please indicate the overall level of recommendation you wish to give this applicant for the Jake Flynn Scholarship.
___ Highest recommendation ___Recommend ___Recommend with reservations ___ Do Not recommend
Additional comments:
Name:______Title:______
Telephone:______Email:______
Signature:______Date: ______
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