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