Pilot International
Scholarship Application
Our Mission:
Pilot International transforms communities by:
developing youth,
providing service and education,
and uplifting families.
The Pilot International Executive Committee has chosen to honor Becky Burrows, Marie
Newton Sepia and Ruby Newhall by continuing to have their names on the scholarships. The
funds for these scholarships and the Pilot International Scholarship are granted through the
Goals for Grants and Scholarships program of Pilot International Founders Fund.
Please review the entire application before completing.
All necessary forms are included but some are unique to one Scholarship.
Please complete all forms necessary for the scholarship you are applying.
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Pilot International Scholarship Application
This application must be postmarked or email time stamped to the District PIFF
Representative by March 1, 2015 and to Pilot International Headquarters by
March 15, 2015.
This application may be used to apply for the following scholarships:
Pilot International
Becky Burrows
Marie Newton Sepia
Ruby Newhall Memorial
This application packet contains:
Scholarship Program Narrative
Scholarship Application Timetable
Policies Governing Pilot International Scholarships
Responsibilities of Applicant and Sponsoring Pilot Club
Scholarship Profile
Student Application
Scholarship Financial Aid Worksheet
Student Agreement
Application Checklist
Completed applications may be mailed or emailed.
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Pilot International Scholarships
Pilot International Scholarship
The Pilot International Scholarship was established in 1988 to provide financial
assistance to undergraduate students preparing for a career working with youth
leadership and development, helping people with brain safety or fitness, or caring for
families during times of need. Scholarships are based on financial need, academic
success, and application contents. Scholarships are awarded for one academic year. A
student may re-apply and be granted the Pilot International Scholarship for no more
than 3 additional years. Award amounts may vary, but will not exceed $1,500 per year.
Applicants must be full time students and if awarded a scholarship must remain a full
time student for the duration of the scholarship.
Becky Burrows Scholarship
The Becky Burrows Memorial Scholarship Fund was established in 2005 from the estate
of Becky Burrows. This fund provides aid to students who are reentering the job
market, beginning “second careers,” or seeking to improve their professional
skills for their current occupation by continuing their education in that field.
Students must pursue courses of study that further Pilot International’s
mission to transform communities through education and service in the areas
of youth development and leadership, brain safety and fitness or caring for
families in need.
Becky Burrows lived in Arlington, Virginia and was a member of the Pilot Club of
Arlington Northeast Potomac District, for 38 years. She was one of the first nine
employees at the International Monetary Fund where she worked for 29 years. She
was very friendly and spent much of her time at Pilot events making guests feel
welcome. She was also very helpful to new Pilots. She attended more than 25 Pilot
International Conventions where she often served as a doorkeeper.
Although award values may vary, scholarships will not exceed $1,000 per year for fulltime students and $500 per year for part-time students. Scholarships may be used for
study through the Doctorate degree level.
The Marie Newton Sepia Memorial Scholarship
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The Marie Newton Sepia Memorial Scholarship Fund was established in 1983 as a part
of Pilot International to provide financial aid to a qualified graduate or doctorate
student preparing for or currently working in careers related to youth
development and leadership, brain safety and fitness or caring for families in
times of need. M. Fred Sepia made the initial contribution to the fund in memory of
his wife, Marie, who was a long-time member of Pilot International and served as
International President in 1968 – 1969. It is intended that this fund will, as augmented
in the future, permanently further Pilot International’s mission by assisting worthy
capable individuals to pursue careers in which they will teach, encourage and
rehabilitate children with disabilities.
The amount granted for one full academic year will not exceed $1,000. Applications
must have received a Bachelor’s degree from an accredited college or university in any
country where Pilot clubs exist. Applicants may be full or part time students whose
courses will, in the judgment of the Scholarship Division, be proper background courses
for teaching and working with disabled children. Postgraduate work or research should
improve the skills of the applicant in dealing with brain-related disorders / disabilities of
children.
Applicants must agree, in writing, to work with children with brain-related disorders /
disabilities upon completion of the postgraduate training or research, to the terms and
conditions of the scholarship and to follow such administrative procedure prescribed by
the committee.
Ruby Newhall Memorial Scholarship
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The Ruby Newhall Memorial Scholarship was established in October 1949. Ruby
Newhall was from Gainesville, Florida and was president of Pilot International. Her
contacts with international students at the University of Florida strengthened her belief
that these students could contribute significantly to improving international relations.
Ruby Newhall’s dream of a scholarship fund to enable international students to study in
the U.S. and Canada became a reality after her death in 1949 when her family
suggested scholarship contributions in her memory in lieu of flowers. The Ruby
Newhall Memorial Scholarship Fund became a part of Pilot International in 1975.
Scholarship funds, not to exceed $1,500 are disbursed for one full academic year and
must be used for tuition and related educational expenses considered necessary by the
Executive Committee. Assistance may only be extended to students who are studying
through the doctorate level.
An applicant for the Ruby Newhall Memorial Scholarship must be from a foreign country,
pursuing a degree in the United States or Canada. The field of study must be of a
nature that it improves the quality of life for the community in their home country. The
applicant must have spent at least one semester in a college in the United States or
Canada by the application submission date and have a cumulative grade point average
of 3.0 on a 4.0 scale. The applicant must be a full time student and remain a full time
student for the duration of the scholarship.
The student must have a documented Visa at the time the application is completed,
submitted, graded and the scholarship is awarded. Failure to have a valid Visa at any
time during this process could disqualify the student.
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Policies for All Pilot International Scholarships
▪
The Executive Committee of Pilot International will provide the overall administration of
the scholarship funds.
▪
The Executive Committee, through the Scholarship Division, may receive
recommendations for scholarships from any Pilot Club, District, and / or the Executive
Committee of Pilot International, in accordance with existing administrative procedures.
▪
March 1 is the postmark / email date deadline for local clubs to send their completed
scholarship application packets to the District Pilot International Founder’s Fund
Representative (hereafter to be referred to as PIFF’s).
▪
The Scholarship Committee will review and grade scholarship applications and make
recommendations to the Executive Committee of Pilot International. The Scholarship
Committee will recommend as recipients of scholarships those persons who, in the sole
judgment of the Committee, are best suited to further the purposes of the fund.
▪
Scholarship funds may be used for tuition and related educational expenses considered
necessary by the Executive Committee. Actual amounts awarded may vary.
▪
In accordance with IRS regulations, officers, directors, trustees, employees, or current
members of the Scholarship Committee of Pilot International are not eligible for
scholarship programs sponsored by Pilot International.
▪
When an application has been approved, the sponsoring club will be notified and
payment will be made in one installment directly to the applicant’s educational institution
upon receipt of the appropriate forms.
▪
Once approved, a student may reapply annually by submitting an updated application
and supportive documents – if the club elects to continue sponsorship of the student.
However, any given student may be awarded a total of three (3) scholarships during
his / her academic career.
▪
A scholarship applicant is limited to one scholarship award annually. If an applicant is
eligible for more than one scholarship, the Scholarship Committee members will decide
on the scholarship most appropriate for the individual.
▪
A club may submit only 2 applicants each scholarship period.
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Sponsoring Pilot Club Responsibilities
• Screen applicants in cooperation with officials of the college / university. The
Club PIFF Representative should carefully review the applicant’s scholarship
request and the application procedures. Clubs are strongly encouraged to
personally interview applicants. Only those applicants who meet or exceed the
minimum qualifications required by the scholarship should be recommended for
an award.
• Guarantee that the application is typed or printed.
• Provide the completed original applications and supporting documents, (in the
order listed) to the District PIFF Representative postmarked or email date
stamped by March 1.
▪
▪
▪
▪
▪
▪
▪
▪
▪
Sponsorship Profile
Sponsorship Letter from Club
Student Application
Student’s Transcript(s)
Financial Aid Worksheet
Two letters of Recommendation
Student Agreement (signed by student and 2 witnesses)
Summary of Volunteer Service / Employment History
Checklist
• Make sure the applicant understands the policies governing the scholarship
program and the terms of the Student Agreement and remains aware of its
provisions throughout the term of the scholarship.
• Familiarize the recipient with Pilot International’s principles so the student will be
a good Pilot ambassador.
• Inform the recipient of the approval / denial of the scholarship and formally
award if possible.
• Work closely with the student to ensure that the payment is requested in time.
To do this, the student must have the school complete the Registration
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Verification Form and send to Pilot International Headquarters with a current
transcript. The scholarship payment must be requested within six
months after the scholarship is awarded or the scholarship is
automatically cancelled.
• Pilot Club members are encouraged to invite the student to at least one club
meeting per year. Clubs should also contact the student regularly and assist the
student as needed.
Scholarship Applications that are incomplete or do not include all of the
appropriate documentation will not be processed.
Other Information for Clubs
Sponsorship Letter from Club:
A letter, signed by the Club President and Club PIFF Representative, stating that, to the
best of it’s knowledge, the club believes the applicant meets the qualifications for the
scholarship, and the club voted to recommend the applicant. This letter should indicate
the club membership voted to sponsor this applicant and the meeting date that this
vote was taken.
Student’s Transcript(s):
These should be the most recent college-level course work. Transcripts downloaded
from school websites are accepted if unaltered and URL is visible at the bottom of the
printed page. The student’s cumulative GPA must be listed. If GPA is not
listed, an official paper copy must be requested by the applicant from the
school’s registrar and submitted with the application.
Two letters of Recommendation:
These should address character, commitment, and ability. Letters must be dated within
12 months of the date of application. The letters should be from qualified persons such
as a professor who has taught the applicant, a faculty advisor, or an employer. If
these arrive in sealed envelopes, the club should open the envelope to verify
the letter.
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Sponsorship Profile
(To be completed by the Sponsoring Pilot Club)
This form is for ALL scholarships
Scholarship Choice:
Pilot International (undergraduate)
Amount of Pilot International Scholarship Requested:
!
___
$1,500 (Senior)
___
$1,275 (Junior)
___
$1,050 (Sophomore)
___
$750 (Freshman)
!
Marie Newton Sepia
Becky Burrows
!
Ruby Newhall Memorial
Applicant’s Name:
_________________________________________________
Permanent Address:
_________________________________________________
Phone / Email:
_________________________________________________
Name and Location of College / University Applicant Will Attend:
_______________________________________________________________________
Is this College / University Accredited:
___
Yes
___
No
Type of Term:
___
Quarter
___
Semester
___
Other
Grading Scale:
___
4.0
___
5.0
___
Other
Specify Term / Year for which Scholarship is being requested:
________________
Student’s Academic Status at the beginning of the Term of the Scholarship: _________
Will Student be:
___
Full Time
___
Part Time
# of Credit Hours: _____
Cost of One Year’s Study: $___________
Student’s Major:
__________________
Planned Degree:
How did your club learn of the applicant’s needs:
________________
___________________________
_______________________________________________________________________
How did your club determine the applicant’s scholarship eligibility?
___
Personal Interview
___
Other (please explain)
___
Telephone Interview
_____________________________________
_____________________________________
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Has your club fully explained the policies governing this scholarship program to the
applicant?
___ Yes
___ No
Has your club verified that the applicant has provided official transcript(s)?
___
Yes
___
No
By signing this form, the club agrees to fulfill its responsibilities as outlined in the
scholarship process.
Club PIFF Representative
Club President
Printed Name:
_______________________
________________________
Address:
_______________________
________________________
_______________________
________________________
Phone:
_______________________
________________________
Email:
_______________________
________________________
Signature:
_______________________
________________________
Pilot Club:
_______________________
District:
__________________
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Ruby Newhall Memorial Scholarship
Student Application
(Information must be typed)
This form is for the Ruby Newhall Scholarship ONLY.
A.
Biographical Information:
Applicant’s Name:
_________________________________________________
U.S. or Canadian Mailing Address:
______________________________________
______________________________________
______________________________________
Phone / Email:
_________________________________________________
Name & Address of Nearest Relative:
______________________________________
_______________________________________________________________________
Date and Place of Birth:
_________________________________________________
Length of Time in U.S. or Canada:
______________________________________
Do you have IMMIGRATION documentation that states you are legally in the U.S.?
____ Yes
____ No
PLEASE ATTACH A PHOTOCOPY OF APPROVED IMMIGRATION DOCUMENTS
Academic Record
1.
Educational Background:
Please provide the name and location of the schools you have attended:
Elementary: ___________________________________________________________
Secondary:
___________________________________________________________
College/University: ______________________________________________________
Degree Granted (if applicable):
2.
___________________________________________
Current Educational Information:
Name and Address of College / University you are attending or plan to attend:
____________________________________________________________
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Academic Status at the beginning of the term of scholarship:
___
Freshman
___
Sophomore
___
Junior
___
Senior
___
Graduate
___
Post Graduate
Hours needed to complete current academic level:
_________________________
Planned degree _____________________ Anticipated Graduation Date ____________
Degree Area
(To show that this will improve the quality of life for the community in the home country)
__________________________________________________________________________________________________________
Most Recent GPA ______
B.
C.
Cumulative GPA ______
Career Plans
1.
Write a 100 – 150 word essay explaining how you will use your
education.
2.
Write a 100 – 150 word essay explaining how you will be able to foster
better international relations after completing your education in the
U.S. or Canada.
Financial Need
A financial aid worksheet is included with this application. Please carefully
follow all instructions that are listed on the worksheet. You will have to
have the college financial aid office assist you with this worksheet.
D.
Volunteer Service / Employment Record
Attach a summary of volunteer hours and employment history. You
may also include a current resume.
E.
Letters of Recommendation
Attach two letters of recommendation dated within 12 months of this
Application.
F.
Make sure your application is complete including the checklist.
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Student Application
(Information must be typed)
This form is for all scholarships EXCEPT Ruby Newhall
Applicant’s
Responsibilities: All applicants must:
• Furnish such supporting data as the Scholarship Committee may request so the
relative merits of the applications may be judged.
• Have and maintain a cumulative grade point average of 3.25 on a 4.0 scale and a
4.01 on a 5.0 scale.
• Have completed at least 12 semester hours in a college in the United States or
Canada by the application submission date.
• Be willing to sign and abide by the terms of the Student Agreement.
Scholarship Choice:
Pilot International (undergraduate)
!
Becky Burrows
!
Marie Newton Sepia
Biographical Information:
Applicant’s Name:
_________________________________________________
Permanent Address:
_________________________________________________
Phone / Email:
_________________________________________________
Current Occupation:
_________________________________________________
(if more than student)
Name & Address of Nearest Relative:
______________________________________
_______________________________________________________________________
A.
Academic Record
1.
Educational Background:
Please provide the name and location of the schools you have attended:
Secondary:
___________________________________________________________
College/University: ______________________________________________________
Degree Earned (if applicable):
___________________________________________
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Academic Status at the beginning of the term of scholarship:
___
Freshman
___
Sophomore
___
___
Senior
___
Masters Candidate ___
Most Recent GPA ______ Cumulative GPA ______
Additional hours needed to complete degree:
Junior
Doctoral Candidate
Hours Completed ______
_______
Planned degree _____________________ Anticipated Graduation Date ____________
2.
Name and Address of College / University you are attending or plan to
attend:
____________________________________________________________
Telephone Number _________________ Fax __________________
B.
Career Plans
1.
What are your educational goals? (Include curriculum and major to be
pursued)
_________________________________________________________
_________________________________________________________
_________________________________________________________
2.
What are your career goals in 100 – 150 words?
_________________________________________________________
_________________________________________________________
_________________________________________________________
3.
C.
The mission of Pilot International is to improve the quality of life for
people who are brain injury survivors and / or live with another brain
related disorder or disability. In an essay of 100 – 300 words explain
how you will use your education to further this mission.
Financial Need
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1. Describe your financial situation:
______________________________________________________________
______________________________________________________________
______________________________________________________________
2. Please give your estimated expenses and other sources of funding for the
upcoming academic year.
A financial aid worksheet is included with this application. Please carefully
follow all instructions that are listed on the worksheet. You will have to
have the college financial aid office assist you with this worksheet.
3. Note your tentative course schedule:
___
Full Time
___ Part Time
____ # of Credit Hours
D.
Attach a summary of volunteer hours and employment history. You
may also include a current resume.
E.
Attach two letters of recommendation dated within 12 months of this
application.
F.
Make sure your application is complete including the checklist.
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Financial Aid Worksheet
This form must be completed & submitted whether or not
the student received financial aid
This form is for ALL scholarships.
Check One:
___
Full Time
___ Part Time
Part 1 – to be completed by the student
Complete Part 1 of the Financial Aid Worksheet (FAW), authorizing release of
information and submit it to your Financial Aid Office which should complete Part 2.
The FAW should then be returned to you with a signature and an official stamp affixed
to the bottom.
Name: ___________________________________
Permanent Mailing Address:
ID # ______________________
___________________________________________
___________________________________________
Phone / Email: _________________________________________________________
I authorize you to release the information requested in Part 2.
Student’s signature: _____________________________________________________
Part 2 – to be completed by the school’s financial aid officer
Please complete sections A – E, sign, affix an official stamp of the school, and return
directly to the student. Only this original FAW is acceptable. Thank you in advance for
your assistance. If tuition cost has not yet been determined for the upcoming year,
please use the current year’s costs.
Section A.
Estimated Student Expenses for Academic Year $_______________
Tuition
$_______________
Fees
$_______________
Books
$_______________
Living Expenses
$_______________
___
On Campus
Total Expenses (a)
___
Off Campus
___
With Family
$_____________
Name: ___________________________________
ID # _______________________
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Section B.
Assistance received or benefited from at this institution. (Include and
indicated estimates if actual amounts are not available.)
List all Grants/Scholarship Awards
Amount
_____________________________________
$_____________
_____________________________________
$_____________
_____________________________________
$_____________
_____________________________________
$_____________
Total (B)
$___________
Section C.
Student loan history at this institution (Include estimates if actuals are
not available.)
Type (Received/Pending)
Date
Amount
______________________________
_________
______________
______________________________
_________
______________
______________________________
_________
______________
______________________________
_________
______________
Total (C)
$___________
Section D.
Please list total amount personally contributed by the student or the
student’s family.
Total (D)
Section E.
$___________
Financial Aid Officer must sign this section.
Financial Need Analysis
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Student Expenses (A)
$______________
Less
Estimated Aid (B + C)
$______________
Family Contributions (D)
$______________
Equals
Estimated Need
$______________
__________________________________
Authorized Signature
________________
Date
__________________________________
Printed Name
________________
Title
Name of Institution:
____________________________________________
Phone:
________________________
Email:
____________________________________________
Ruby Newhall Scholarship Student Agreement
This form is for the Ruby Newhall Scholarship ONLY.
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I have applied for a Ruby Newhall Memorial Scholarship from Pilot International.
Should a scholarship be awarded to me, I understand and agree to comply with the
following policies:
1. I will be aware of my representative of Pilot International and my school and
uphold the ethics and principles of both.
2. I will notify Pilot International in advance of any intent to change my major or
curriculum from the one approved for my scholarship. Notification will be made
prior to making such a change, as it could alter my scholarship eligibility.
3. I will correspond with Pilot International at least once each term while this
scholarship is in effect and will furnish official transcript of my grades for every
term the scholarship is in effect.
4. I understand I am to have current immigration documents at all times.
5. I understand I cannot solicit funds from Pilot members or Pilot Clubs.
6. I fully understand that unless the Registration Verification form and current
official transcript(s) are sent by December 1, after the scholarship is awarded,
the scholarship is automatically cancelled.
7. I understand the scholarship is for one full academic year as an undergraduate
for graduate student through the doctorate degree level and that I must maintain
full-time status.
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8. I intend to return to my home country within six months after the completion of
the scholarship or further studies and will remain there for at least two years. I
will use the training I have received for the advancement of human health,
education, and welfare of my fellow countrymen.
_________________________________
Applicant’s Printed Name
_____________________
Date
_________________________________
Applicant’s Signature
Please provide the following information from two witnesses:
Witness #1
Witness #2
Printed Name:
_______________________
________________________
Address:
_______________________
________________________
_______________________
________________________
Phone:
_______________________
________________________
Email:
_______________________
________________________
Signature:
_______________________
________________________
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Student Agreement
This form is for all scholarships EXCEPT Ruby Newhall.
Check one:
___
Full Time
___ Part Time
I have applied for a scholarship from Pilot International. Should a scholarship be
awarded to me, I understand and agree to comply with the following policies:
▪ I will be cognizant of my representative of Pilot International and my school and
uphold the ethics and principles of both.
▪ I will notify Pilot International in advance of any intent to change my major or
curriculum from the one approved for my scholarship. Notification will be made
prior to making such a change, as it could alter my scholarship eligibility.
▪ In order to continue receiving this scholarship, I understand that I must maintain
a cumulative grade point average of 3.25 on a 4.0 scale and a 4.01 on a 5.0
scale.
_________________________________
Applicant’s Printed Name
_____________________
Date
_________________________________
Applicant’s Signature
Please provide the following information from two witnesses:
Witness #1
Witness #2
Printed Name:
_______________________
________________________
Address:
_______________________
________________________
_______________________
________________________
Phone:
_______________________
________________________
Email:
_______________________
________________________
Signature:
_______________________
________________________
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Pilot International Scholarship Checklist
This checklist shows all requirements for all scholarships. This sheet MUST be included with the application
packet. If items are not completed and / or included, the application CANNOT be processed.
Applicant
Club
District
Deadlines have been met.
Application is typed or printed including essays.
Completed Forms:
Sponsorship Profile
Sponsorship Letter from Club
Correct Student Application (Including Essays)
Student Transcript(s)
Financial Aid Worksheet
Two Current Letters of Recommendation
Correct Student Agreement with Witnesses
Volunteer Service & Employement History
GPA meets Criteria
Current Immigration Documents
(Ruby Newhall Only)
Student Meets Criteria
Checklist
Signatures:
Club President:
Date:
Club PIFF:
Date:
District PIFF:
Date:
Scoring Ranges
A. Academic Record (15-25)
D. Volunteer Service/Employment (1-20)
B. Career Plans (15-25)
E. Letters of Recommendation (1-5)
C. Financial Need (10-20)
D. Volunteer Service/Employment (1-5)
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