KMC Scholarship Application
Military Spouse 2014
ELIGIBILITY:
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Must be the spouse of a United States Military Member or DoD
civilian command-sponsored assigned to a Kaiserslautern Military
Community installation (excluding geographically separated units
[GSUs]) or the spouse of a United States Military Member, Retired,
residing in the KMC.
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The applicant must reside in the KMC.
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The applicant may not have previously received two ROSC, RESA,
KLSA or KMC Scholarships.
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Applicant and sponsor must possess valid US military or DoD
civilian ID cards.
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Applicant must have a cumulative grade point average of 3.0 or better
(GPA based on a 4.0 scale). Official transcripts are required.
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Applicant must not PCS before May 15, 2014.
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Applicant must hand deliver the application.
KMC Scholarship Application
Military Spouse 2014
Application Instructions:
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Print or type, using ONLY available spaces on this form. If additional
space is required, continue on 8 1/2” x 11” white paper, properly titled,
with SSN (Last 4 ONLY) placed in upper right corner. Do not attach a
resume. Do not staple your application; paperclips only.
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Make 2 copies of pages 5 & 6.
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The applicant is responsible for gathering and submitting all necessary
information and official documents. Applications are evaluated on the
information supplied. Answer all questions completely. Give
specific dates and contact individual when required. The KMC
Scholarship Committee retains the right to verify any and all
information given in the application.
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If the application is incomplete or information is falsified, your
application will automatically be disqualified.
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The completed application must be hand delivered to the Scholarship
Committee during one of the following dates:
February 5, 2014 between 1700-1900
February 6, 2014 between 1700-1900
February 7, 2014 between 1700-1900
The committee will be set up in the entrance of the Ramstein Officer’s
Club.
YOU MUST HAVE YOUR US MILITARY ID OR DOD CIVILIAN
ID WITH YOU WHEN YOU TURN IN YOUR APPLICATION.
KMC Scholarship Application
Military Spouse 2014
LIMITATIONS:
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Scholarship funds are to be used within the 2014-15 academic year for
undergraduate or graduate studies.
Scholarship funds awarded may be used for college related expenses only at an
accredited college, university, or technical school.
Payment of scholarship awards will be made directly to the selected school. The
recipient MUST provide the KMC Scholarship Committee with the name and
address of the school via the “Payment Form” which will be given to every
award winner. The form must be returned NO LATER THAN JUNE 13th or
the award may be returned to the KMC Scholarship Fund.
GENERAL INFORMATION:
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The Scholarship Committee is comprised of members representing the Ramstein
Officers’ Spouses’ Club (ROSC), Ramstein Enlisted Spouses’ Association
(RESA), and the Kaiserslautern Landstuhl Spouses’ Association (KLSA).
Scholarship funds come from all three organizations.
This application is for eligible spouses who are in, or will begin undergraduate or
graduate studies at an accredited college, university, or technical school in the
2014-2015 academic year.
The Scholarship Committee reviews and determines applicant eligibility and
selection criteria.
Financial need is not taken into consideration.
Submission of application does not guarantee a scholarship.
The Scholarship Committee determines the number and monetary value of each
scholarship to be awarded based on available funds and application score
analyses.
Recipients are not eligible to receive more than two (2) ROSC, RESA, KLSA or
KMC Scholarships over the course of their education.
The Scholarship Committee members and their family members are not eligible
to apply for this scholarship.
Judges and their family members are not eligible to apply for this scholarship.
Awards are granted without regard to branch of service, race, gender, ethnicity,
religion, or disability.
Applicants will receive a written notification of results.
KMC Scholarship Application
Military Spouse 2014
Application Checklist:
This application becomes complete and valid only when all of the pages listed
below are hand delivered BY THE APPLICANT with a valid US Military or
DoD civilian ID.
ALL MATERIALS MUST BE SUBMITTED AT THE SAME TIME.
Each page of the application must include the last four digits of the applicant’s SSN
in the space provided in the upper right hand corner.
Please have all the following with you when turning in your application:
Valid US Military or DoD civilian ID
Privacy Act Statement
Page 1
Certification Letter (signed and dated by applicant and sponsor)
Page 2
Photo Release
Page 3
Personal Data Packet
Pages 4-6
Official Transcripts from all colleges &/or high school if less
than 20 college credit hours completed
Page 7
Copy of educational, activity, leadership, community service,
awards and data sheets
Page 8
Applicant’s Last 4 digits of SSN
Privacy Act Statement
PRIVACY STATEMENT. Since the Ramstein Officers’ Spouses Club (ROSC), the Ramstein Enlisted
Spouses’ Association (RESA) and the Kaiserslautern Landstuhl Spouses’ Association (KLSA) whose
members comprise the KMC Scholarship Committee are private, non-profit corporations, the Privacy Act
of 1974, 5USC 552a, is not applicable; however, the ROSC, RESA and KLSA regard the lawful and correct
treatment of personal information as important to our successful operations and to the maintenance of
confidence of those with whom we deal. We will ensure our staff and those acting on our behalf obtain, use
and disclose personal information lawfully and correctly. We will only collect and process personal
information to the extent that is needed to fulfill our operational needs, and we will take appropriate
security measures to safeguard your personal information.
The KMC Scholarship Committee wants participants to be fully aware of the need for and the intended uses
of the information provided. To that end, please read and acknowledge the following privacy statement by
signing below.
“We, the applicant and parent/sponsor, are voluntarily providing personal information with this application
based on the recognized necessity of the data to allow for the proper evaluation of the applicant’s eligibility
for a KMC Scholarship. We understand that failure to provide all requested information may impact the
selection process. Furthermore, we fully understand that:
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Participation in the KMC Scholarship is voluntary.
The requested information is needed for that participation.
The principle purposes of the requested information are to:
1.
2.
3.
4.
5.
Verify the identity of the applicant.
Determine the applicant’s eligibility for the program.
Permit administrative processing and evaluation for scholarships.
Allow required servicing and administrative management of approved scholarships
Publicize scholarship recipients in various publications.
We acknowledge the foregoing privacy policy and hereby authorize the KMC Scholarship Committee to
disclose information relating to this application for scholarship whenever the disclosure is necessary for the
processing, servicing, granting or publicizing of said scholarship. We further understand that, as a result of
this consent, the KMC Scholarship Committee will not keep an accounting of disclosures of information
regarding this application for scholarship since this notice informs us of the uses which may be made of the
information. We authorize the KMC Scholarship Committee or its representative, as required, to verify any
information herein by contacting an appropriate office or official.”
Applicant’s Signature
Date
Sponsor’s Signature
Date
PAGE 1
Applicant’s Last 4 digits of SSN
KMC SCHOLARSHIP COMMITTEE
CERTIFICATION LETTER
If I accept a KMC Scholarship, I certify I will abide by the following conditions (initial each)”
Scholarship funds are to be used within the 2014-15 academic year for undergraduate or
graduate studies.
Scholarship funds are to be applied to college related expenses at an accredited
college, university, or technical school.
The KMC Scholarship, when combined with other scholarships, must not exceed the
cost of college related expenses for the applicable academic year. Any remaining funds
must be returned to the KMC Scholarship Committee as soon as possible.
If I receive and accept a full scholarship (to include tuition, fees, room and board, or
books) I will be INELIGIBLE for this KMC Scholarship award. I will notify the
Scholarship Committee upon my acceptance of such a scholarship.
As a scholarship recipient, I must provide the COMPLETED PAYMENT FORM with
the information necessary of the school where I am accepted for the 2014-15 academic
year to the Scholarship Committee NLT June 13, 2014. Payment of the scholarship
money will be made directly to the selected school NLT August 1, 2014.
It is my responsibility to notify the KMC Scholarship Committee of any change of status
(e.g., change of schools, change in address, etc.). Failure to do so may result in the
forfeiture of my scholarship award.
If my application is incomplete, if I have falsified information, or if I have
previously been awarded two KMC scholarships, my application will automatically
be disqualified.
Unclaimed funds as of September 15, 2014 revert to the KMC Scholarship Fund.
Special circumstance or exceptions are at the discretion of the committee.
If any of the above conditions are violated, scholarship funds must be returned to the
KMC Scholarship Fund.
I agree that my signature on this form will authorize the KMC Scholarship Chair to release this
application, including the last four of my social security number, GPA, and transcript(s) to the
Scholarship Committee, as needed.
I certify that all information in this application is accurate and complete to the best of my
knowledge.
Applicant’s Name (Printed)
Signature
Date
Sponsor’s Name (Printed)
Signature
Date
PAGE 2
Applicant’s Last 4 digits of SSN
PHOTO RELEASE
If I accept a KMC Scholarship, I agree to have my photo taken by the KMC
Scholarship Committee for purposes of social media, newspaper print, and other
public media.
I agree that the KMC Scholarship Committee may use my photo with or without my
name for any lawful purpose, including for example such purposes as publicity,
illustration, advertising and web content.
I have read and understood the above statement:
Applicant’s Name (Printed)
Signature
Date
Sponsor’s Name (Printed)
Signature
Date
PAGE 3
Spouse
Applicant’s Last 4 digits of SSN
PERSONAL DATA INFORMATION
APPLICANT’S INFORMATION:
NAME (Last, First, Middle)
Applicant’s Last 4 Social Security Number
(SSN):
Current Mailing Address:
Current Local Address:
Are you a current member of the Ramstein Officers’
Spouses’ Club, Ramstein Enlisted Spouses’ Association
or the Kaiserslautern Landstuhl Spouses’ Association?
(Additional points given for membership)
YES
NO (Please Specify)
Home Phone Number:
Club:
Cell Phone Number:
Email Address:
Name:
SPONSOR’S INFORMATION:
NAME (Last, First, Middle)
Sponsor’s Email Address:
Sponsor’s Organization:
Duty Station:
Duty Phone Number:
PAGE 4
Applicant’s Last 4 digits of SSN
Spouse
PERSONAL DATA INFORMATION
EDUCATIONAL DATA
High School where you received your diploma and
Colleges attended
Dates Attended
From Mo/Yr — To Mo/Yr
If you have less than 20 college credit hours, you must also submit your official High School transcript or GED certificate.
Cumulative College OR High School GPA (To be completed by KMC Scholarship
Committee)
LEADERSHIP ROLES:
List all leadership roles held within service, religious, and other community organizations.
Last 4 years only 2010-present
Position Title
Contact
Individual
Organization
Years of
Participation
Awards and Honors
Last 4 years only 2010-present
Award/Honor
Organization
Contact Individual Date Received
ROSC
PAGE 5
Applicant’s Last 4 digits of SSN
Spouse
PERSONAL DATA INFORMATION
COMMUNITY/VOLUNTEER SERVICE: List volunteer work with service, religious, and
community organizations.
Last 4 years only 2010 - present
Position Held
Organization &
Location
Contact Individual
Hours
Please add your total hours of volunteer service.
PAID EMPLOYMENT:
List paid employment for the last 4 years only.
Last 4 years only 2010 - present
Job Title & Description
Contact Individual
Hours
Please add your total hours of employment.
Parenting Data: List AGES ONLY (NO NAMES) of all children who
are command sponsored by applicant’s sponsor, under the age of 20,
living with you.
Son, 17 years
Date of birth
MM/DD/YYYY
05/10/1996
PAGE 6
Spouse
Applicant’s Last 4 digits of SSN
OFFICIAL TRANSCRIPTS
ATTACH DOCUMENTS TO THIS
PAGE
PAGE 7
Spouse
Applicant’s Last 4 digits of SSN
Copies of Awards, Certificates,
Employment Data Sheets, etc.
ATTACH DOCUMENTS TO THIS
PAGE
PAGE 8