Seymour Football Parents Club Scholarship Application

Seymour Football Parents Club Scholarship Application

High School Student Application

The Seymour Football Parents Club is offering two $500 scholarships to use for higher education. This scholarship is exclusively for seniors on the Seymour Football team who plan to pursue an undergraduate degree or certification from an accredited college, university or technical school.

Eligibility Requirements

1) The student must have completed their senior season to qualify.

2) The student must be a senior who will graduate during the school year in which the award is being applied for.

3) The student must have completed requirements for a Core 40 diploma at minimum.

4) The student must have no violations of their school’s athletic code of conduct.

5) The student must not have been ejected from any contest due to unsportsmanlike conduct.

6) The student must verify that they have made a commitment to remain substance free throughout high school.

Award Disbursement

1) The Seymour Football Parents Club Scholarship is to be used for tuition, books and/or other fees.

2) The one time disbursement will be a check made to the winner and to the two or four year college, university or technical school in which the winner is enrolled (full time).

3) The Seymour Football Parents Club Scholarship winner must submit proof of enrollment from their college, university or technical school prior to disbursement.

4) The Seymour Football Parents Club Scholarship winner will be announced at the Seymour High School’s Honors Day Program.

Application Instructions

1) ALL PARTS OF THIS APPLICATION MUST BE COMPLETED AND SIGNED. All information included in this application will be treated as confidential. Incomplete or unsigned applications will be disqualified.

2) A typed essay (see requirements below) must accompany the application.

3) The personal information sheet will be the only sheet in the application that will have the applicants name on it. For anonymity purposes, the applicant will put the last four digits of their Social Security number in the top right hand corner of all other information sheets.

4) The application and essay are to be put in a “clear” folder with the personal information sheet attached to the front of the folder with a paper clip.

5) A minimum of one letter of recommendation is required. Letter must contain person’s name, address, phone, title, relationship and number of years known. For judging criteria, a copy will be made whiting out any reference that might identify the applicant.

6) Completed signed application, letter of recommendation(s) and essay must be received on or before April 2, 2018. Applications should be turned into the Seymour Football Parents Club at P.O. Box 761, Seymour, IN 47274 or via email at .

Essay Topic and Requirements

An essay written by the applicant must accompany the completed scholarship application and must meet the following criteria:

1) Only the last four digits of the applicant’s Social Security number should be included in the upper right-hand corner of the essay. No other information that identifies the applicant should be included on the essay.

2) The essay must be typed and double-spaced on 8 1/2” x 11” white paper with one inch margins on all sides.

3) The essay should be at least 200 words minimum.

4) The essay topic is: “What playing football at Seymour has meant to me”.

Section 1 – High School Student (Applicant)

Personal Information Sheet

Name: ______Social Security Number:______-_____-______

Street Address:______City:______State:_____Zip:______

Date of Birth:____/_____/_____ Email:______Phone:______

By signing this form, I confirm the following:

1. I have remained substance free, and pledge to remain substance free, throughout my high school career.
2. I have never been ejected from a contest for unsportsmanlike conduct.
3. I have never violated my school’s code of conduct.
4. I confirm that the information listed above is accurate.

Consent/Release

I attest that the information within that I have provided is true and accurate. I also understand that my name and photograph may be used by the Seymour Football Parents Club for public relations purposes.

Signed:______Date:______

Section 2 – Parent(s)/Guardian(s)

Personal Information:

Name:______Occupation:______

Name:______Occupation:______

Street Address:______City:______State:_____Zip:______

______

Email:______Phone:______

Number of household members:______

Number of household members attending college in 2018-2019:______

Consent/Release

I ______, attest that the information I have provided is true and accurate. I also understand that my child’s name and photograph may be used by the Seymour Football Parents Club for public relations purposes.

Parent/Guardian Signature:______Date:______

Printed Name:______

Parent/Guardian Signature:______Date:______

Printed Name:______

Page 1 –

(Last 4 Digits SS# ______)

Section 3: High School Information

Extracurricular Activities/Organizations/Teams: Grades Participated

9 10 11 12

Community Activities/Organizations: Grades Participated

9 10 11 12

Page 3 –

(Last 4 Digits SS# ______)

Section 3 – High School Student (Continued)

Honors and Awards received through extracurricular or community involvement:

Years that you played Football / Team played on / Letter Earned:

(Place an X in column of year and team played on. Circle the X if Letter was earned)

9th Grade 10th Grade 11th Grade 12th Grade

Employment Information:

Current and/or previous employers:

Reasons for working:

Page 4 –

(Last 4 Digits SS# ______)

Section 3 – High School Student (Continued)

College Information:

Colleges, Universities, and/or Technical Schools applied to:

Colleges, Universities, and/or Technical Schools accepted into:

College, University or Technical School planning to attend:

Planned field(s) of study:

Other scholarships or awards received and amounts of each:

Career goals:

Section 4 – High School Official

School Official Information

Name:______Title:______

School Address:______City:______State:____Zip:______

Email:______Phone:______

Student Information

Cumulative GPA:______out of______Class Rank:______out of______

Total Number of Absences (high school career):______ACT Total:______

SAT Totals:______

Critical Reading Score:______Math Score:______Writing Score:______

Yes No

Will student graduate with a Core 40 curriculum?

Will student graduate with a Core 40 academic honors diploma?

Will student graduate with a Core 40 technical honors diploma?

Will student be a Seymour Scholar?

Will student be a 21st Century Scholar?

Signed:______Date:______

HAVE YOU INCLUDED:

SAT Scores______

ACT Scores______

GPA______

Class Rank______

Essay______

High School Verification______