Application Form

Run4Beau Scholarship Program 2015
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DEADLINE for scholarship applications is April 30, 2015 (no exceptions).
Refer to criteria below for eligibility requirements.
If any question does not apply to you in this application please put N/A in the space.
Type or print legibly. Illegible applications will be returned to you. You may also download a copy of the
application online at www.run4beau.com.
5. If you have any questions about the application, please call _740-357-6946.
NOTE: Scholarship funds will be awarded to the student upon evidence of registration in an accredited postsecondary institution.
Purpose: To provide scholarships to qualifying Pike County Ohio graduating seniors interested in or intending to
pursue post-high school course of study at either college/university or other post-secondary educational institution.
Four (4) scholarships will be awarded.
Award Components: Four (4) $1000 scholarships and individual certificates awarded to Four (4) students selected
by the Run4Beau Scholarship Committee.
Criteria:
1. Applicant must be a Pike County Ohio School District resident.
2. Applicant must be a graduating high school senior in the year of the award.
3. Applicant must demonstrate positive-impact involvement, and be a part of extracurricular
activity/activities.
Application Process:
Applicant must submit the following items:
1. Completed application form (if handwritten, please print legibly)
2. Three (3) letters of recommendations from choice of high school teachers, administrators, counselors,
employers, or individual with significant knowledge of applicant’s experience and involvement.
3. Personal Essay. In your essay, please answer the following question on the enclosed essay form.
Describe how your personal background has influenced your academic and long term goals.
4. Bill from college.
Deadline for the application is April 30, 2015. Applications postmarked after this date will not be considered.
Please mail application to/ or submit your completed application to your school guidance counselor :
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Run4Beau Scholarship Program 2015
“Run4Beau”
Scholarship Program
PO Box 482
Waverly, OH 45690
Please type or print your answers. If application is illegible it will be returned to you.
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Last Name:
First Name:
Mailing Address:
Street: _________________________________________________________
City:
State:
ZIP:
3.
Daytime Telephone Number: (
4.
Date of Birth:
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Current High School:
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I will be attending the following school in the Fall of 2015: ___________________________________
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I will be entering the above-mentioned school as a: (Circle one)
Freshman
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Month
)
Day
Year
Number of years
attended:
Sophomore
Name & address of parent(s) or legal guardian(s): Use reverse side of application if you need more space.
Name (s)
______________________________________________________________________________
Street: ___________________________ City:_____________________ State: ______
ZIP:_____________
Home phone of parents or legal guardians:
Number of years
attended:
9.
Name and city of other high schools attended:
10.
List the name of any college you have attended.
11.
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B.
C.
What specialty major do you plan to major in as you continue your education?
Year
Began
Year
Ended
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Run4Beau Scholarship Program 2015
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List your academic honors, awards and membership activities while in high school:
List your community service activities, hobbies, outside interests, and extracurricular activities:
Academic Questions:
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What are your short term career goals? (Example: One to five years after graduation):
15.
Personal Essay
Please answer the following question:
Describe how your personal background has influenced your academic an long term goals.
(See last page)
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Run4Beau Scholarship Program 2015
16.
A. The following items must be attached to this application in order for the application to qualify to be
reviewed by the scholarship committee.
B. Your application will be returned to you if these items are not attached to this application. (No
exceptions.)
C. Circle “YES” or “NO” to be sure you have attached each item as required.
YES
NO
YES
YES
YES
NO
NO
NO
Three (3) reference forms. Return these completed forms in a sealed envelope from your
teachers, professors, etc.
List all extracurricular activities.
Expense statement from University.
Personal Essay
“Describe how your personal background has influenced your academic and
long term goals.”
STATEMENT OF ACCURACY
I hereby affirm all the above stated information provided by me is true and correct to the best of my knowledge. I also
consent that my picture may be taken and used for any purpose deemed necessary to promote the scholarship
program.
I hereby understand if chosen as a scholarship winner, according to Run4Beau Scholarship policy, I must provide
evidence of enrollment/registration at the post-secondary institution of my choice before scholarship funds can be
awarded.
Signature of scholarship applicant: _________________________________
Date: _______________________
REMEMBER
The deadline for this application to be received is -_April 30, 2015 No exceptions!
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Run4Beau Scholarship Program 2015
Personal Essay
Describe how your personal background has influenced your academic and long term goals.
(Use this page as your cover letter, submit handwritten or in APA format…not to exceed 1000 words)
Name:_________________________________________
Date:__________________________________________
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