YMCA of Metropolitan Dallas
2021 Y-Scholars
College Scholarship
Application
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A. STUDENT PROFILE
Last Name First Name Middle Initial D.O.B
Home Address City State Zip Code Telephone #
E-mail: _______________________ ________________________________________________
ο Male ο Female My local YMCA is: Ethnicity:
Please check all that are applicable: (Y Staff (Y Leader/Fundraiser (Y Program Participant (Y Parental Involvement (Staff or Board)
B. EDUCATIONAL DATA **Attach Official HS transcripts & Copy of SAT and/or ACT scores**
Please do not send documents that you need returned!
Name of High School City State Current Rank Class Size GPA (4.0 scale)
SAT Score ACT score Name of College You Plan To Attend Anticipated Major
Mailing Address of College:
Occupation I plan to pursue:
C. RESOURCE DATA **Attach a copy of both parents’ 2019 or 2020 1040**
**Please note: you may black out social security numbers on the form. At completion of screening,
documents will be shredded.
________________________
Father’s Name Address City State Telephone #
Occupation Employer $Taxable Income
Mother’s Name Address City State Telephone #
Occupation Employer $Taxable Income
Number of children in your family and their ages:
How many family members will attend college next year? (include yourself) : ____________
Annual cost of college you plan to attend (Tuition, Room & Board): $ ____________
Amount of money you have saved for college? $
Have you applied for Financial Aid? οYES οNO If YES, for what? _______ ____________
What languages do you speak?
D. PERSONAL STATEMENTS (2)
Attach both statements to the application. One statement per page, single spaced. Statements must be at least a page long but no longer than 2 pages. BOTH statements must be completed.
1. Describe who you are (not what activities you have participated in) and relate it back to why you are the one who should receive one of the Young Men's Christian Association Scholarships.
2. Describe how the YMCA has influenced your life or the life of someone you know.
E. RECOMMENDATIONS (2)
Attach to your application two letters of recommendation from your counselor, teacher, youth pastor, school principal etc.
They should highlight their relationship with you, the character qualities they see in you and the number of years they have known you.
F. EXTRA CURRICULAR ACTIVITIES
Attach a resume/list of extracurricular activities on a separate page.
G. SIGNATURES
Please obtain the appropriate signature. YMCA Director should be the Teen Director, the Executive Director or someone designated by the Teen Director or the Executive Director of your local YMCA. Go to to find your local YMCA.
__________________________________________________ ____________________________________________________ ______________________________________________________________
Student’s Signature / Date Parent/Guardian Signature / Date YMCA Director/Designee Signature / Date
H. CHECK LIST / FINAL INSTRUCTIONS
Use the following checklist to ensure that all of the necessary contents are included with your application. Failure to submit any part of this list will result in automatic disqualification! Also, be sure that the contents are stapled together and are arranged in this order! Do not fold.
ο Completed application
ο Personal statements (2)
ο Résumé or other activity summary
ο Recommendation letters (2)
ο Copy of SAT and/or ACT report (Required)
ο Official High School Transcript
ο Copies of parents’ most current income tax information (1040)
Please Note and check the following:
ο Mailed application (in large envelope) must be postmarked by Monday, February 8th, 2021.
ο Candidates must be available to attend interviews on either Saturday, March 6th or
March 13th , 2021 from 8:00am to 12:00pm. In case of inclement weather, please be available for the makeup date of Thursday, March 18th, 2021 from 5:30 to 9:30pm. No other interview date will be made available. If a date is out of the question, please note that here: ___________________________________.
Observe the deadline –postmarked by Monday, February 8, 2021. Only official H.S. transcripts are accepted. Copies of SAT or ACT records will be accepted. Upon receipt of all requested materials, a scholarship committee will review the information. In fairness to all applicants, the Scholarship Review Panel consists of volunteers only. Due to the high volume of questions, inquiries will only be accepted via email at collegescholarship@. Remember, if selected, candidates must be available to attend interviews on Saturday, March 6th or March 13th, 2021 from 8:00am to 12:00pm (or makeup date of March 18th).
No other interview date will be made available.
MAIL OR DELIVER YOUR APPLICATION AND REQUIRED PAPERWORK TO:
T. Boone Pickens YMCA – Scholarship Department
601 N. Akard St., Dallas, TX 75201
Please Note: No faxes or emailed applications will be accepted
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