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|Notes to Candidates for Scholarship: You must submit your materials to the Gadsden County High School Senior Counselor . All sections of application should |
|be filled out properly, in addition to the essay question. Contact info will be detailed at the end of application. Please submit all documents for |
|scholarship by May 6, 2019. Selected candidate will be rewarded in the amount of $1000.00 for his/ her 1st year of higher learning with confirmed |
|transcripts in both fall/spring semesters of scholastic year. |
|I, | |have read and understand the conditions of the "G20/20” Scholarship Scholarship as explainedddd |
|that’s explained in the current Notes to Candidates for Scholarship box. I affirm that I plan to pursue an education of higher learning as defined in these |
|documents provided. I give permission to officials of my institution to release transcripts of my academic record and other information requested for |
|consideration in the Graham’s 20/20 program. I understand that this application will be available only to qualified people who need to see it in the course |
|of their duties. I affirm that all of this application, including the policy proposal, is my own work for formally cited from other sources. I affirm the |
|information contained herein is true and accurate to the best of my knowledge and belief. |
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|Signature | |Date ____________ | |
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|Legal name in full | | | | |
|(Print/Type) | | | | |
| |Last Name |First Name |Middle Name | |
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|Permanent residence | |
| |Number, Street, and Apartment Number |
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| |City |State |ZIP |
|School Address | |
| |Number, Street, and Apartment Number |
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| |City (if studying abroad, add country) |State |ZIP |
|How is permanent residence established? |Home telephone |( ) |
|(At least two must apply.) | | |
|Home address for school registration | | |
|Place of registration to vote | | |
|Family’s primary residence | | |
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| |School telephone |( ) |
| |(if different) | |
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| |E-mail address | |
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| Other: | |Date of birth | |Age | |
| | |Month/Day/Year | |
|(Check one) I am a U.S. citizen U.S. national Resident alien expecting citizenship by the date of award |
|Will you be studying attending higher learning at a University/ Collage, and/or Technical Institution? Yes No |
|(If yes) Where? | |Please include acceptance letter. |
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|Name of nominating institution | |
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|Current cumulative GPA | |on a scale of | | |
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|Number of high school credits earned date | |Total number of credits required for graduation | |
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|Expected date to receive high school diploma | |Technical certification receive | |
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|List the High school from which you graduated and all higher education institutions attended. Include dual enrollment, study-abroad, exchange programs and|
|technical certification programs (up to six). |
|School |Location |Dates Attended |
|List high school activities (student government, sports, publications, school-sponsored community service programs, student-faculty committees, arts, |
|music, etc.). List in descending order of significance. You will have space for up to 10 high school activities. |
|High Activity |Dates |Offices |
|List public service and community activities (homeless services, environmental protection/conservation, advocacy activities, work with religious |
|organizations, etc.). Do not repeat items listed previously. List in descending order of significance. You will have space to list six. # of |
|Weeks |
|Activity |Role | Dates |Active |
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| |Application – 2 of 5 | | |
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|Name | | |
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|List government activities (internships with government agencies, partisan political activities, ROTC/military, municipal boards | |
|and commissions). List student government under Item 2. | |
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| |# of Weeks |
| |Active |
|Activity |Role |Dates | |
|List part-time and full-time jobs and nongovernment internships up to high school graduation. |
| | | |Average # of |
|Type of Work |Employer |Dates |Hours/Week |
|List awards, scholarships, publications or special recognitions you have received. List in descending order of significance. |
|Describe one specific example of your leadership. (The writer of your letter of recommendation re: Leadership Abilities and Potential must confirm this |
|experience.) |
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|Approved for use through 08/03 |
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|Describe a recent particularly satisfying public service activity (do not repeat experience described in 7). |
|9. Describe the problem or needs of society you want to address when you enter public service. (If possible, use statistical data to define the magnitude |
|of the problem.) |
|10. What are the three most significant courses you have taken in preparation for your career? |
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|Describe the graduate education program you intend to pursue if you receive a Graham’s 20/20 Scholarship. |
|What do you hope to do and what position do you hope to have upon completing your graduate studies? |
|What do you hope to do and what position do you hope to have five to seven years later? |
|What additional personal information do you wish to share with the Graham’s 20/20 Scholarship Foundation? |
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|Essay Question (At Least 250 Words): If you had the authority to change your school in a positive way, what specific changes would you make? (Please use |
|additional sheet of paper, type and double space, if needed) |
For further information please contact Shaquille O’Neal Graham at (850) 980-2228 or via email at s.oneal.graham@
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