Northland JC Foundation
Scholarship
2010 Application and Information
Purpose: The purpose of this scholarship is to provide A+ students
enrolled in, or entering, the Kansas City (Missouri) Metropolitan Community College system,
in pursuit of a two or four-year college degree in a field related to Leadership, Management and/or Community Service, with
funding for books required by the curriculum.
Scholarship Amount: $500 ($250 per semester, for two semesters within one
academic year beginning in the fall following presentation of award). The scholarship award selection process
is handled entirely by the Scholarship Advisory Committee of the Northland JC Foundation. The NJCF will
be responsible for notifying applicants as to their acceptance or denial of the scholarship, which will be awarded in May
2010.
Criteria: In order
to be eligible for the scholarship, the student must:
Have and maintain a GPA of 2.5 or above
Be
enrolled with a minimum of 12 credit hours per semester at a Kansas City Metropolitan Community College
Include a current
transcript with application and semester renewal.
Guidelines: Scholarships will be awarded on an annual basis and disbursed
on a per semester basis. Recipients must provide an official transcript within ten (10) days after the
completion of each semester certifying the number of credit hours taken and the GPA maintained in order to qualify for additional
semester funding, as well as, any changes to the original application (i.e. contact information, course of study, etc) and
statement of intention for upcoming semester. (If summer semester will be skipped, notification should
be made to remain eligible for the following fall semester.) The scholarship is NOT automatically renewable.
Qualifications and deadlines MUST be adhered to for consideration and are the responsibility of the applicant.
NOTE: Only 2010 Northland JC Foundation Scholarship Application forms should be used (attachments
are permitted). Prior year’s forms should be destroyed.
Recipients are expected to attend
the Senior Honors/Awards Night of their school in May to receive scholarship.
Deadlines: Failure to meet deadlines will result in disqualification.
· Applications
for scholarships from 2010 graduating Seniors attending high schools in the
Park Hill and North Kansas City School districts MUST BE POSTMARKED BY Friday, April
2, 2010 and must be received by April 8, 2010. Scholarship
renewals MUST BE RECEIVED
within ten days following the end of the semester. ONLY renewals
may be submitted via e
-mail to David@njc-foundation.org.
.
NOTE: Completion of the accompanying scholarship application is entirely voluntary;
however, failure to provide requested information / documentation or to meet eligibility requirements or deadlines may result
in immediate disqualification for the NJCF Scholarship without consideration. We are not responsible
for late, damaged, lost or misdirected mail. Adherence to ALL deadlines is the sole responsibility of the
applicant
Please submit application and current transcript to: Northland
JC Foundation
Attn: Scholarships Committee
6300 N. Indiana Ave.
Gladstone, MO 64119
Note: Questions relating to this application should
be referred to the NJCF President David G. Page, at (816) 436-1555 or David@njc-foundation.org.
PLEASE RETAIN COPY FOR FUTURE REFERENCE
2010 Northland JC Foundation
Scholarship Application
NOTE: Completion of this application is entirely voluntary;
however, failure to provide requested information / documentation or to meet eligibility requirements or deadlines may result
in immediate disqualification for the NJCF Scholarship without consideration.
(PLEASE
PRINT OR TYPE LEGIBLY)
PERSONAL DATA
Name: ______________________________ Nickname (if applicable): _______________
Last
First MI
Date of Birth: ___________________
Social Security Number: ____________________
Gender:
Male Female (Circle one)
Home Address: _______________________________________________________________
(Street)
(City) (State)
(Zip
Home Phone:
________________________ Cell Phone: _________________________
E-mail addresses:
_____________________________________________________________
Website or blog (such as My Space, Face Book, etc.):
_____________________________________________________________________________
Parent(s)/Guardian(s) Name(s):
_____________________________________________________________________
Parent(s)/Guardian(s) Address (if different from yours):
___________________________________________________
ACADEMIC DATA
High School Name: _____________________________________________________
School Address:
______________________________________________________________
(Street)
(City) (State) (Zip
Year of High School Graduation:
Cumulative GPA: _____________ ACT/SAT score(s): ______
(Please attach transcript and results of ACT/SAT tests if available)
College you will be attending: (If you are
presently enrolled in college, please attach current transcript)
Name _________________________________________________________________
Address: ___________________________________________________________________
(Street)
(City)
(State) (Zip
Why do you want to attend this school? __________________________________________________________________________
__________________________________________________________________________
What is your intended
field of study? __________________________________________
What do you hope to do with your education? _______________________________________________________________________
What do you hope to do with your education?
_______________________________________________________________________
_______________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
SCHOOL AND COMMUNITY INVOLVEMENT
List any organizations in which you
have been a member or jobs in which you have been employed. (Organizations may include academic, athletic,
civic, religious or social groups. Jobs may also include volunteer work or internships.) BE
SURE TO INCLUDE: Number of years, positions or offices held. List any awards, honors or recognition received: _________________________________________________________
__________________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
FINANCIAL INFORMATION
Will you be utilizing the Missouri A+ program for your future education?
YES
NO
________________________________________________________
________________________________________________________
________________________________________________________
FINANCIAL INFORMATION
Will you be utilizing the Missouri A+ program for your future education?
YES
NO
FINANCIAL INFORMATION
Will you be utilizing the Missouri A+ program for your future education?
YES
NO
Will you be applying for, or receiving any other forms of financial assistance in addition
to the A+ program? Yes
No
If yes, please list names and amounts:
_________________________________________________________________
_________________________________________________________________
________________________________________________________
What expenses, in addition to tuition, do you anticipate in the next two years of your intended
education (include text books, lab fees, etc. and itemize if known)? _____________________________________________________________
What percent of your college expenses, listed above, are you or your family
paying for?
Do you plan to work
during the school year? YES NO
Full Time? YES NO Part
Time? YES NO
Do you qualify for full or partial paid school lunch at this time?
YES NO (If yes, specify which.)
FULL PARTIAL
OTHER INFORMATION
Let us know anything that you believe
makes you uniquely qualified to receive this scholarship? (Keep in mind that the sponsor emphasizes interest
in Leadership, Management and Community Service.)
_____________________________________________________________________________________________________________
___________________________________________________________________________________________
____________________________________________________________________________________________
ACKNOWLEDGEMENT AND RELEASE
I hereby confirm that all information provided on this application is true and correct and I understand that
any false information automatically disqualifies me from eligibility. I intend to continue my education
in the Kansas City Metropolitan Community College system and understand that failure to do so may result in my disqualification
even if I have already been awarded the scholarship. I plan to attend my school’s Senior Awards/Honors
Night barring extreme circumstances. I authorize the Northland JC Foundation to use my name, age, school,
educational goals, school/community involvement, photo or likeness, and any other information that I specifically authorize,
in the media or for promotional purposes in perpetuity without additional compensation.
\
Signature of Applicant
______________________________ Date ____________
Printed name of Applicant
________________________________ Age _______
Signature of Parent/Guardian (if applicant is under 18) _
_______________________________________________________ _____
Date _____________
Printed name of Parent/Guardian _____________________________________________
Relationship ______________
OPTIONAL INFORMATION:
Are you interested in participating in the events of the Northland JC Foundation (such as their Annual 5k run/walk
to benefit education or their entry in the Snake Saturday Parade)? NOTE: The
answer to this question in no way impacts your eligibility to receive this scholarship and is used only as a means of identifying
persons interested in becoming involved in other programs of our organization.
YES, I WOULD LIKE
TO BE INVITED TO PARTICIPATE IN THE ACTIVITIES OF THE NJCF.
NO, I AM NOT INTERESTED IN PARTICIPATING IN THE ACTIVITIES OF THE NJCF.
Scholarship applications MUST be received by April 8, 2010, for the North Kansas City and Park Hill School Districts
Mail applications and attachments
to: Northland JC Foundation
Attn: Scholarships Committee
6300
N. Indiana Ave.
Gladstone, MO 6411o