2016 VYC Scholarship Program

Instructions

●Please review all guidelines before completing application

●Type in Arial 10 point font or write legibly using black ink

●Please use only allotted space, unless noted otherwise

●Be sure to read and sign the Application Certification Page

●The deadline is September 30, 2016.. Applications postmarked after this deadline will not be accepted

Applicant Information

NAME: ______BIRTH DATE: _____/____/_____

Last First MI

ADDRESS: ______

Street Apt # City State Zip

Home Phone: ______Cell Phone: ______

EMAIL: ______

Which Scholarship are you applying for? (Please check all that apply)

Merit Scholarship Community Service Scholarship Scholars Scholarship

Secondary Education – List all secondary (high schools) attended:

Name of School / Address / Yrs Attended / Graduate? (Y/N) Date / Cumulative GPA (4.0 Scale) Class rank

Undergraduate Education (If any) – List all institutions attended at undergraduate level

Name of School / Address / Major/ Minor / Years
Attended / Expected Graduation date & degree / Cumulative GPA (4.0 Scale) Class rank / Major GPA
(4.0 Scale)

Graduate Education (If any) – List all institutions attended at the graduate level

Name of School / Address / Field of Study / Years
Attended / Expected Graduation date & Degree / Cumulative GPA (4.0 Scale) Class rank / Major GPA
(4.0 Scale)

Honors/Awards (If any) – List your academic or other awards you’ve received, Please start with most relevant

Award/ Honors / Institution or Organization / Date / Describe Award

Volunteer Experience (If any) – List your volunteer experience. Please start with most relevant

Organization / Roles and Responsibility / Duration
(MM/YY)
(MM/YY) / Reason for Leaving / Total Hours / Required (Y/N)

Extracurricular Activities (If any) – List your extracurricular activities. Please start with most relevant

Organization / Roles and Responsibility / Duration
(MM/YY)
(MM/YY) / Reason for Leaving / Total Hours / Required (Y/N)

Essays:

Please use Arial size 12 Font, double spaced, black ink on white paper

●Short Essay:Have you experienced a moment of epiphany, as if your eyes were opened to something you were previously blind to? What was it and what did you realize?

●Merit: Describe your most meaningful achievement and how it relates to your field of study and your future goals.

●

●Scholar: How will your study of ______contribute to your immediate or long range career plans?

●Community: Discuss something you’ve done that’s made a difference in your community.

Please include the names of two (2) individuals as references that we may contact.

(Name, Relation, Phone Number / E-mail)

1. ______

______
2. ______
______

Application Checklist

✓Application Form – Fully completed, signed, initialed at end of each page

✓2 Essays – 1 Short answer (no more than 200 words), 1 Scholarship specific (no more than 250)

Application Certification

□I hereby certify that all of the information that I have provided in this application is true and correct. I have not knowingly withheld any facts or circumstances that could interfere with the truthfulness and accuracy of my application.

□I have read all the guidelines and meet all the stated conditions.

□If selected as a recipient, I shall abide by the terms and regulations of the Scholarship*

□If selected as a recipient I give the Vraj Youth Committee permission to release my name, institution, and image for Vraj Youth Committee and Vraj publication purposes.

*Selected recipients of the Vraj Youth Scholarship award must volunteer at Vraj during the Annakut celebration on November 15th, 2015 to be entitled to half of the award. The recipient will be entitled to the second half of his/her reward after volunteering at another Vraj/Vraj Youth event between Annakut 2015 and Annakut 2016.

Please forward completed applications to
Jharna Mehta

4481 MacArthur Blvd NW Apt B3

Washington, DC 20007

______

Print Name
______
Date

______
Signature

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