The Presidents’ Council Foundation

PC Scholars Application

PC Scholars Program

Application 2010 - 2011

Directions and Checklist

Please review the following checklist to ensure your application is complete:

Sophomore student at CMSD high school

G.P.A of 2.5-3.0

Copy of year-end report card from previous school year

Work Permit eligible or 16 years of age by June 2010

Completed signed application with all documents

When completed, submit your application and documents by Wednesday, October 6, 2009 by using one of the following methods:

Fax completed application and documents to 216-771-3679

Complete online at

Mail completed application and documents to:

The Presidents' Council, 1120 Chester Avenue, Suite 200-PC, Cleveland, OH44114

Drop off completed application and documents by 4:00pm Monday – Friday to:

The Presidents' Council, 1120 Chester Avenue, Suite 200-PC, Cleveland, OH44114

Return to your guidance counselor and have them fax or mail the completed application and documents

PC Scholars Application Timeline

Wednesday, October 6, 2009 -Applications due to The Presidents' Council Foundation

Saturday, October 16, 2009 - Selection process completed

Friday, October 22, 2009 - Notifications of selection sent to selected participants and guidance counselors

Saturday, November 6, 2009 -PC Scholars sessions begin

Should questions arise pertaining to this application, please contact Nicole Bell, Director of Programs or Athena Nimmer, Program Coordinator at (216) 771-8702 or

Incomplete applications will not be processed. Please be sure to print clearly.

Last Name: ______First Name: ______Middle Initial: ______

Preferred Name: ______Gender: □ Male □ Female Age: ______

Address: ______Apt or Suite: ______

City, State,and Zip: ______

Cell Phone #: ______Home Phone#: ______

E-mail Address: ______Date of Birth: ______

Student ID number/Social Security Number: ______

Household Information: □ Two Parent □ Single Parent □ Grandparent(s) □ Guardian

PARENT/GUARDIAN INFORMATION:

Mother/Guardian

First Name: ______Last Name: ______

Address (if different from above): ______

______

Home Phone: ______Work Phone: ______

Email Address: ______

Father/Guardian

First Name: ______Last Name: ______

Address (if different from above): ______

______

Home Phone: ______Work Phone: ______

Email Address: ______

RACE/ETHINICITY:

___ American Indian/Alaskan Native ___ Asian ___ African American/Black ___ Caucasian

___ Native Hawaiian/Pacific Islander ___ Hispanic/Latino (a) ___ Other

SCHOOL INFORMATION:

High School: ______

High School Curriculum: College Prep ______General _____ Vocational ____

Anticipated Graduation Date: ______

GPA: ______(*please include a copy of your year end report card)

ACT/SAT/OGT*(planned date for test): ______

High School Counselor’s name: ______

High School Counselor’s telephone number: ______

High School Counselor’s Email: ______

CAREER INTERESTS:

Please select top three career fields that interest you and rank them 1-3, 1 being the most interest:

Business Administration _____Health Science/Health Care _____

Construction Technologies_____Law_____

Entrepreneurship_____Manufacturing Technologies_____

Financial Services_____ Other, Please specify______

Please answer the following questions completely.

  1. List your extracurricular activities, special interests, and hobbies. List each activity and circle the corresponding grade level. (Use a separate sheet if necessary.)

______7 8 9 10

______7 8 9 10

______7 8 9 10

______7 8 9 10

______7 8 9 10

______7 8 9 10

  1. List significant awards and honors you have received. List each award or honorand circle the corresponding grade level. (Use a separate sheet if necessary.)

______7 8 9 10

______7 8 9 10

______7 8 9 10

______7 8 9 10

______7 8 9 10

  1. List your employment and volunteer experiences.

Position/Job TitleEmployerEmployment Dates

______

  1. In 100 words or less, please explain your after high schools plans and career goals?

Submissions should be in 12-point font, typed, and double spaced. Please be sure to proof-read your submission.

  1. The PC Scholars Program focuses on improving the lives of select African-American CMSD students through Leadership- focusing on teamwork and communication, Academic Achievement- focusing on writing and listening skills, test-taking skills and college preparation, Life Skill – healthy living, resiliency skills and financial literacy and Career Preparedness- focusing on entrepreneurialism, experience and exploration.

In 100 words or less, please explain how this program will affect your life, what are your after high school plans, your career goals, and why youshould be selected as a participant. Submissions should be in 12-point font, typed, and double spaced. Please be sure to proof-read your submission.

Understand that the information provided in this application is confidential and that it will not be disclosed to anyone who is not affiliated with the program. I certify that the information provided is accurate and complete. I further agree that if I am chosen to be a participant in this program, I will participate in all of the sessions and activities provided.

______Student’s Signature Date

______

Parent/Guardian’s SignatureDate

1