D.T.A./F.T.A. SCHOLARSHIP APPLICATION
General Information- Diamond R-IV is offering two scholarships (individual maximum of $150) to senior
members. Members only may apply for the scholarships. Applications must be submitted by May 3rd.
Please fill out all areas pertaining to the type of assistance you are requesting.
Scholarship awards will be determined based on the following: Leadership, (GPA, class rank, ACT
scores), service in F.T.A. and whether the applicant will go into teaching.
Payment- The scholarship money will be paid directly to the recipient.
Applicant’s name:
________________________________________________________________
Home Address:
________________________________________________________________
City __________________________ State _________ Zip _______________
Telephone _______________________________________________________
Years of membership in F.T.A. ______________
List any F.T.A. committees/activities you have helped with: ___________________________________
____________________________________________________________________________________
Have you received any other scholarships?
Yes/ No
If yes, what scholarships have you received? _______________________________________________
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Do you work in addition to attending school?
Yes/ No
Do you plan to enroll as a full-time student in college? Yes/ No
Program/Institute Choice
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City _________________________ State ________ Zip __________
Telephone _______________________________________________
Major/Class ______________________________________________
Applicant’s Signature _______________________________________________ Date _____________
Criteria List
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College entrance examination score (ACT) __________________________________________
Student’s cumulative grade point average (GPA) _____________________________________
Has college prep curriculum been followed? Yes/ No
List student’s classes and grade earned for terms indicated:
Junior Year Classes
Grade
Senior Year Classes
Grade
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5. Extracurricular activities- Organizations and clubs, years of involvement, offices held, volunteer
work, etc.:
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Criteria List (Cont.)
Please describe, in no less than 250 words, reasons why you want to be in the education
field. Include leadership abilities, community services, academic achievements, proposed
occupation, and any other information that you feel applies.