| First Name: |
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| Middle Initial: |
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| Last Name: |
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| Email Address: |
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| Permanent Home Street Address (including Apartment #): |
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| City/Town: |
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| Zip Code: |
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| Home Phone: |
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| Cell OR Alternative Phone: |
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| Gender: |
Male
Female
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| For which scholarship are you applying? (select all applicable) |
Bohart
Cowles
National Semiconductor
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| HIGH SCHOOL: Name of High School you will graduate/have graduated from. |
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| HIGH SCHOOL: Expected Date of Graduation (MM/YYYY) |
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| COLLEGE/UNIVERSITY COURSES: If you have taken/are taking courses at a college/university, please list them below and indicate which college/university. |
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| STANDARDIZED TESTS: Please indicate below your results to-date on any of the following examinations: SAT/ACT/AP/IB . If you have not yet received your scores, then submit them as soon as you recieve them. If you have not yet taken the SAT of ACT, but plan do do so, please indicate when below. (ex: SAT 11/07 TTL 1200 Verbal 600 Math 600 Writing -) |
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| ACADEMIC HONORS: List below any major academic honors or distinctions you have recieved in grades 9-12. Please be specific in explaining them. Upload an additional Word document if necessary. |
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| PRELIMINARY ACADEMIC INTEREST: Briefly describe (1) preliminiary area(s) of academic interests or fields of study and (2) why those areas interest you. |
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| Parent(s)/Guardian Name (First & Last): |
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| Parent(s)/Guardian Phone Number(s): |
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| Did your parent(s)/guardian attend college? |
Yes, they did attend college.
No, they did not attend college.
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| SIBLINGS: Please the names and ages of all your siblings and indicate their highest level of education. (ie: Adam/9/Elementary) |
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| EXTRACURRICULAR INTEREST & ACTIVITIES: In order of importance, tell us about interest or activities to which you have committed significant amounts of time and energy during grades 9-12. For each activity, be sure to describe: (1) The extent of your involvement -- hours per mo. and # of mos. (2) High school year(s) involved - 9/10/etc. (3)Positions held and/or honors/recognitions recieved (4) Any other information you want the Selection Committee to consider. *Upload additional documents if needed** |
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| EMPLOYMENT: Please indicate any work experiences you have had in grades 9-12. For each job, be sure to describe: (1) The amount of time involved (hours per week & number of months) (2) Which years you were employed (9/10/etc.) (3) Positions held and recognitions received (4) Any other information you want the Selection Committee to consider **You may attach a resume or additional document if needed.** |
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| BACKGROUND: Briefly describe any special circumstances or barriers that you have overcome which have had an impact on you or your family. (Attach a seperate document if necessary) |
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| Additional Documents UPLOADED: |
Copy of Official High School Transcript
Copy of Official Results from SAT or ACT, when taken
Recommendation Letter (from a non-relative)
Autobiographical Essay (short paragraph about yourself)
Resume (not required)
Additional Essay (if required)
Additional Document (for lengthy answers/more space needed)
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| UPLOAD TRANSCRIPT/SCORES: Please upload transcrip/score copies here. |
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| UPLOAD ESSAY: Please upload your Autobiographical Essay here. |
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| UPLOAD Additional: Upload additional documents here. |
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| UPLOAD Additional: Upload additional documents here. |
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| Documents Being MAILED: |
Copy of Official High School Transcript
Copy of Official Results from SAT or ACT, when taken
Recommendation Letter (from a non-relative)
Autobiographical Essay (short paragraph about yourself)
Resume (not required)
Additional Essay (if required)
Additional Document (for lengthy answers/more space needed)
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| CERTIFICATION: Please certify this application by checking the boxes below to idicate that you agree with each statement. (ALL boxes must be checked inorder to submit an application for consideration!) |
I am a graduating high school senior who is a participant in the Big Brothers Big Sisters of North Texas program.
I acknowledge that I have received the scholarship requirements and understand the procedures.
To apply for this scholarship, I agree to furnish all required documentation by the established deadline.
I understand that the information provided in this application shall be used by Big Brothers Big Sisters for the purpose of evaluating my application.
I consent to the disclosure of all information in this application to Big Brothers Big Sisters, its directors, representatives, and employees for the purposes described.
I certify that all information submitted in the application process – including the application, personal essays, and supporting materials – is factually true and honestly presented.
I understand that I may be subject to scholarship revocation should the information I have provided be false.
I also understand that if I am awarded this scholarship, all initial and continuing requirements must be met by the stated deadlines or this scholarship will be terminated.
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| CERTIFICATION: I agree with all eight (8) statements listed above. |
Yes; please accept my application.
No; I withdraw my application.
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