2016 application

2016
Richard P. Erickson
Scholarship Program
for children and grandchildren of
Lifetouch employees
PHOTOGRAPHY FOR A LIFETIME
TYPE OR PRINT ALL INFORMATION EXCEPT FOR SIGNATURES. If space provided in any section proves inadequate, information may be continued on
additional sheets of paper and attached to the application. Application postmark deadline: February 20, 2016
For Scholarship Management Services Use Only.
I.D. No.
AA
PD
RIC/CS
GPA
SAT/CR
SATM
SATW
ACTC
TOTAL
Applicant Data
Name
Last
First
Permanent mailing address
Middle initial
Street
Apartment no.
City
State/Province
Date of birth
Month
Telephone
Day
/
Year
ZIP/Postal code
Social Security no. /Social Insurance no. (last four digits only)
Email
Employee Parent, Grandparent, or Guardian Information
Name
Last
First
Job title
Department
City
State/Province
Lifetouch Subsidiary
Middle initial
ZIP/Postal code
Lifetouch Inc. (Lifetouch Media Productions, Lifetouch Services)
Lifetouch National School Studios Inc.
Lifetouch Canada Inc.
Lifetouch Preschool Portraits
Lifetouch Church Directories and Portraits Inc.
Lifetouch Portrait Studios Inc.
Lifetouch Alumni
SUBSIDIARY
Work telephone
/
Social Security no. /Social Insurance no. (last four digits only)
Relationship to applicant
Start date of employment
Month
Day
Year
Eligibility Applicants must be children or grandchildren of employees of the Lifetouch family of businesses who have completed two years of continuous
service as a Lifetouch employee as of June 30, 2015, and must be an employee in the year of application. One ser vice year equals 700 hours of work or
more. Children or grandchildren of Lifetouch retirees, who were in good standing and who met the continuous service criteria at the time of their retirement,
are also eligible.
High School Data
Name of school
Date of graduation
Street
City
Month
State/Province
Year
ZIP/Postal code
Postsecondary School Data
Name of postsecondary school you plan to attend. (If unknown, please list in order of preference the schools to
which applications for admission have been sent.)
Name of school
City
State/Province
Name of school
City
State/Province
4-Year college or university
Vocational/technical school
Other (explain)
Year in postsecondary program next school year:
Major or course of study
Work Experience
2-year community or junior college
Anticipated date of graduation
Month
1
2
3
4
5
Year
Describe your paid work experience during the past four years. Indicate dates of employment in each job and approximate number of
hours worked each week.
Company/Position
From Month/Year
To Month/Year
Hours Per Week
Activities, Awards, and Honors
List all school activities in which you have participated during the past four years (e.g., student government,
music, sports, etc.). List all community activities in which you have participated, without pay, during the past four years (e.g., Boy/Girl Scouts, hospital volunteer,
Special Olympics, etc.). Indicate all special awards, honors, and offices held. Separate high school and college activities.
Activity
No. of Years Participated
Special Awards/Honors
Offices Held
Goals and Aspirations
Make a statement of your plans as they relate to your educational and career objectives and future goals.
Unusual Circumstances
Report and explain how and when any unusual family or personal circumstances have affected your achievement in
school, work experiences, or your participation in school and community activities.
Applicant Appraisal (required)
To be completed by a high school or college counselor or adviser, an instructor, or a supervisor who
knows applicant well. You have been asked to provide information in support of this scholarship application. Please give immediate and serious attention to the
following statements. When completed, please return to applicant or photocopy this section and return to applicant in a sealed envelope.
The applicant’s choice of postsecondary education program is
extremely appropriate
very appropriate
moderately appropriate
inappropriate
very well
moderately well
not well
fair
poor
fair
poor
very well
moderately well
not well
very well
moderately well
not well
The applicant’s achievements reflect his/her ability
extremely well
The applicant’s ability to set realistic and attainable goals is
excellent
good
The quality of the applicant’s commitment to school and community is
excellent
good
The applicant is able to seek, find, and use learning resources
extremely well
The applicant demonstrates curiosity and initiative
extremely well
The applicant demonstrates good problem-solving skills, follows through, and completes tasks
extremely well
very well
moderately well
not well
good
fair
poor
The applicant’s respect for self and others is
excellent
Comments
Name of appraiser
Title
Telephone
Business address
City
State/Province
Signature of appraiser
/
ZIP/Postal code
Date
Transcript Information
1. Students currently enrolled in college or vocational/technical school must include with this application an official transcript of all college or
vocational/technical school grades. Grade reports are not acceptable. Online transcripts must display student name, school name, grade and credit hours earned
for each course, and term in which each course was taken. (Completion of high school information below is not necessary.)
2. High school seniors and students who have completed less than one full term of postsecondary education must include a high school transcript of
grades and have the following section completed by the appropriate school official.
Applicant ranks
Critical Reading
in class of
Math
Cumulative grade point average:
Writing
SAT
English
Math
/Weighted 4.0 scale
Reading
Science
/Unweighted 4.0 scale
Composite
ACT
Name of school official
Title
Telephone
School address
City
State/Province
Signature of school official
Application Checklist
/
ZIP/Postal code
Date
This application for a scholarship becomes complete and valid only when it is returned with the student application and
current complete transcript(s) of grades to:
RICHARD P. ERICKSON SCHOLARSHIP PROGRAM
Scholarship Management Services
One Scholarship Way
Saint Peter, MN 56082
The student is responsible for submitting all materials
to Scholarship Management Services on time.
Postmark deadline: February 20, 2016
Selection of Recipients Scholarship Management Services has the sole responsibility for selecting recipients, basing the decision on criteria set
forth in the program’s descriptive brochure.
Certification In submitting this application, I certify that the information provided is complete and accurate to the best of my knowledge. If requested, I
agree to provide proof of information I have given on this form. Falsification of information may result in termination of any scholarship granted. This application
becomes the property of Scholarship Management Services. (It is recommended you keep a copy for your files.)
Signature of applicant
Date
Signature of employee
Date
One Scholarship Way
Saint Peter, MN 56082
Copyright © 2015 Scholarship America. All rights reserved.
A program of Lifetouch Inc.
PHOTOGRAPHY FOR A LIFETIME