SAEOPP PRE-COLLEGE SCHOLARSHIP APPLICATION
PART I: GENERAL INFORMATION
Name
FIRST
MI
LAST
Permanent/Home Address
(
CITY
STATE
ZIP CODE
)
TELEPHONE #
E-mail address
Social Security #
Date of Birth
Project (Check One)
 UB
 UBMS
 ETS
Gender
Date Entered:
High School Attended/Currently Attending
H.S. Graduation Date
Location/Address
City
State
Zip Code
College/University you will attend in Fall 2010
Location
CITY
STATE
ZIP CODE
High School GPA (on a 4.0 scale):
or
ACT or SAT Scores:
GED Average:
Exam Date:
College Major/Expected Major
Career Goal
PART II: TRIO PROJECT / SPONSOR INFORMATION
Name of director for TRIO project in which you participate Dr. Ronnie Gross
Phone Number (423 ) 439-4002
E-mail address
Sponsor’s Name* Becky Stout
grossrd@etsu.edu
Position/Title Assistant Director
Sponsor’s Institution/Agency East Tennessee State University
Sponsor’s Address1501 University Blvd.
City
Kingsport
State TN Zip 37660
Phone Number (423)392-8044
Name and address of the other person who will provide a second online Letter of Recommendation for you:
Name
Address
1
Applicant’s Name _________________________________________________________________________
PART III HONORS and AWARDS RECEIVED - List the academic or non-academic honors and awards you have
received. YOUR RESPONSE MUST BE PLACED IN AND CANNOT EXCEED THE SPACE PROVIDED.
Date
Name of Honor/Award
Issued By
Received
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
PART IV LEADERSHIP/VOLUNTEER SERVICE INVOLVEMENT/EXTRACURRICULAR ACTIVITIES –
List leadership roles held; service projects, volunteer committees or programs; TRIO activities; or other activities you have
participated in while attending high school. YOUR RESPONSE MUST BE PLACED IN AND CANNOT EXCEED THE
SPACE PROVIDED.
Dates
Name of Activity/Service
Participated
Office Held [Include Date(s)]
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
PART V
CERTIFICATION OF APPROVAL BY PROJECT DIRECTOR
By my signature which appears below, I certify that the student making application for this scholarship is a participant in the
project which I direct and that he or she is otherwise eligible to compete for this award.
DIRECTOR’S NAME
SIGNATURE
2
DATE
PART VI
ESSAY
In the space below, you must submit an essay entitled, “How my Involvement in Educational Talent Search Has Assisted
Me in Preparation for College Success and Success in Life”. Your essay must be typewritten, and it must be between
250-300 words. The essay cannot exceed the space provided and you must sign and date this page where indicated.
By my signature which appears below, I certify that the statements contained in this application are true and complete to the best of
my knowledge. I certify that the essay submitted herein is original and is not under obligation to, or currently being reviewed for
consideration by, any other entity or individual. Further, I provide authorization to SAEOPP to reprint this essay in SAEOPP
publications and to use in public relations activities.
Typed Name
Signature
3
Date
SOUTHEASTERN ASSOCIATION OF EDUCATIONAL OPPORTUNITY PROGRAM PERSONNEL
RECOMMENDATION FOR PRE-COLLEGE SCHOLARSHIP APPLICANT
Applicant’s Name
The individual named above has indicated that you would provide a letter of recommendation in support of his/her
application for a Southeastern Association of Educational Opportunity Program Personnel (SAEOPP) Scholarship. Please
provide a statement in the space provided in what capacity and to what extent you are familiar with the applicant’s academic
background; civic, community and/or educational contributions; honors or awards received; and such other information that
you deem pertinent to the nomination of this individual for a SAEOPP Pre-College Scholarship Award. The criteria for the
scholarship are as follows:
Recommender Contact Information:
Name
Title
Address
City
Work Phone # (
State
)
Zip Code
Home Phone # (
Email:
Date
4
)