Charles “Pete” Conrad, Jr., Scholarship Entry Form
Please fill out this form completely and mail with other requested information
to: Flight Path Learning Center of Southern California
Scholarship Committee
P.O. Box 90234
Los Angeles, California 90009
Deadline for entries to be RECEIVED is Tuesday, May 18, 2010
Name: _________________________________________________________________
Address: _______________________________________________________________
City/State/Zip: ___________________________________________________________
Phone: _________________________________________________________________
email: _________________________________________________________________
Birth Date: ______________________________________________________________
Name of Current School: ___________________________________________________
Current Year of School: ____________________________________________________
Answer the following items (use additional page for more extensive responses)
1. Grade Point Average (must be converted to a 4.0 scale if school is not on 4.0 scale).
2. What is your academic field of interest (major/minor) and/or career goal?
3. What is your best achievement?
4. List all academic awards and honors received, giving specific years for each.
5. List all extracurricular activities including class offices, athletics, clubs and music. Give specific
years for each.
6. List any aviation, aerospace, aeronautics, robotics, engineering or science related activities or
organizations to which you belong.
7. List any community activities showing leadership or character.
8. List any other accomplishments you feel would interest the judges.
9. Write and submit an essay that describes your interest in aviation, aerospace, aeronautics,
robotics or science. Your response MUST identify how your interest relates to aviation.
Essays must be typed and 250 words or less.
10. Include one certified copy of your high school/college transcript of grades.
11. Provide the names and telephone numbers of the two high school/college/university/technical
school faculty members who gave you letters of recommendation. (Enclose the two letters of
recommendation with your application package.)
 Name:_____________________________________________________________
Telephone #:________________________________________________________
 Name:_____________________________________________________________
Telephone #:________________________________________________________
The Deadline for entries to be received is Tuesday, May 18, 2010
Checklist:
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Scholarship entry form
Essay
Transcript of grades
Two letters of recommendation
Flight Path Learning Center of Southern California