Madison Small Scholarship (LCPS)

2015-16 Application

In 2015, Broad Run High School seniorMadison Small suddenly passed away from meningitis at the age of 18. Madison was a well-rounded person and student athlete –very active in and supportive of Broad Run High School,an honor roll student, great athlete and caring friend to many. She was active in her community through volunteer coaching, tutoring and mentoring. Madison is also remembered for her kind heart, fun loving spirit, outgoing personality and inclusive styled leadership abilities.

Through generous donations from friends and the surrounding community, scholarships have been created in honor of Madison to award to deserving high school seniors in Loudoun Countywho have demonstrated good citizenship while making outstanding and lasting contributions to their school and communityby demonstrating a high level of integrity, leadership and involvementwhile actively participating in the high school and community.

Application is to be completed by the Applicant and must be submitted to the High School Counseling Dept. by April 1, 2016 for consideration. Awards will be chosen by the Madison Small Scholarship Committee.

Personal Information:

Name
Address (Street/PO)
City, State, ZIP
Phone Number
Date of Birth
Parent’s/Guardian’s Name(s)

High School(s) Attended:

Years / High School (please also list City & State if not a Loudoun County School)

Post Graduate Information:

College/Accredited Facility you will be attending
Mailing Address
City, State, ZIP
Intended Major/Field of Study
Starting Date

High School Activities:

List high school related activities that you participated in during your high school years including sports, clubs, school groups, Student Leadership, productions, NHS, etc. Under Misc. you can list any leadership positions held, special recognition/awards received or other relevant information. Please attach separate page(s) if more room is needed.

Year(s) / Activity/Sport/Club/Group / Misc.

Community, Religious, Sports, Volunteer, Other Activities:

List all activities outside of school related activities that you participated in during your high school years. (i.e. – Religious Ed. Teacher, Scouts, Sports Teams, Student Tutor, Big Brother/Big Sister, Coach, Service Organization, Fundraising Projects, etc.).Under Misc. you can list any leadership positions held, special recognition/awards received or other relevant information. Please attach separate page(s) if more room is needed.

Year(s) / Activity/Sport/Club/Group / Misc.

Personal Statement:

Please provide a personal statement to at least one of the questions below. Each statement should be no longer than one page in length.

  • What have you done in the past, are currently doing and/or plan to do in the future to make a difference in creating a positive community?
  • What hardship(s) or mistakes have you experienced in your life and how have you overcome it/them? Have you used those experiences to help others?
  • What one person has had the greatest impact on your life, driving you to be a positive influence to others around you and how has that person affected your life and your life decisions?

Letter of Recommendation:

Include at least one letter of recommendation from anon-related adult (teacher, administrator, coach, significant person in your life, neighbor, etc.) about your character, community/school involvement,leadership abilities and/or how you make a positive contribution/impact to those around you. Each Letter of Recommendation should be included in a sealed envelope from the Recommender with your application. Please make sure your name and the Recommenders name are on the outside of the envelope.

High School Transcript:

Please include a copy of your high school transcript with your application.

Signature:

I attest that the information provided in this application is true and valid and that I have completed this application, including the personal statement(s) myself:

______

Applicant SignatureDate

Application Check List

Be sure to complete all items below:

☐You have completed and signed the Scholarship Application

☐You have completed and attached your Personal Statement(s)

☐Letter(s) of Recommendation are attached to application

☐Copy of your High School Transcript is attached

☐Application is given to the your High School’s Counseling Department by 4:00pm, April 1, 2016

(Counseling Dept. – Please forward all submissions to Mary Jo Taylor at LCPS)

FAQs

Name of Award / Madison Small Scholarship Award (LCPS)
Type of Award / One Year, Non renewable award
Application Due Date / April 1, 2016, 4:00pm
Application Submission / Completed Applications, along with Personal Statement(s) and Letter(s) of Recommendation must be returned to your High School Counseling Department/Career Center no later than 4:00pmApril 1, 2016 for consideration.
Counseling Department/Career Center – Please forward all submissions to Mary Jo Taylor at LCPS.
Amount of Awards / A minumum of 2scholarshipswill be awarded to graduating high schoolseniors from Loudoun County Public Schools in the amount of $1,000towards the student’s educational goals.
Eligibility / Graduating Seniors from a Loudoun County Public High Schoolwho are continuing their education at a college, university, technical school, business school or any other accredited learning center.
Study / The award may be used for any post high school course of study pursued at a college, university, technical school, business school, or any other accredited learning center.
Application Form / Application form will be provided to the High SchoolCounseling Departments for distribution and can be found on the LCPS website. Application must be completed entirely by the applicant. Sponsor’s Application must be used.
Date of Award / All Award winners will be announced at the Spring Honors Assembly at the appropriate high schools.
Payment / A check will be issued and sent directly to the college or accredited training facility.

Madison Small Scholarship Application, 2015-16 Page 1