Bellevue PTSA Council
2012-2013 Student Scholarship Application
The Bellevue PTSA Council is accepting applications for its annual scholarship awards. We
administer three scholarships and award eleven $1,000 individual scholarships to exceptional students
in the Bellevue School District (BSD): the Dr. Michael Riley Memorial Scholarship (5), the Alice
Hurd Memorial Scholarship (5), and the Bellevue Parks Scholarship (1).
Dr. Michael Riley Memorial Scholarship: The intent of this scholarship is to recognize well-rounded
students with outstanding academic credentials. One scholarship is awarded to the top candidate at
each of the five BSD High Schools (5 total).
Alice Hurd Memorial Scholarship: The intent of this scholarship is to recognize exceptional
volunteerism in students. Applicants must have a minimum of 500 hours of community service work.
One scholarship is awarded to the top candidate at each of the five BSD High Schools (5 total).
Bellevue Parks Scholarship: The intent of this scholarship is to recognize a student who has
demonstrated a passion for the outdoors and can express the value Bellevue’s outstanding parks
contribute to the quality of life. The recipient must show a focus on the environment, earth sciences or
recreation leadership. One scholarship is awarded to the top candidate of all BSD High Schools (1).
This application packet may be used to apply for one or more of the above-named scholarships.
Application for more than one scholarship through submission of a single joint application does not
limit your ability to win more than one scholarship nor does it guarantee award of all scholarships
should you be awarded one scholarship.
Application Deadline: April 1, 2013
Applications must be postmarked or delivered by 5:00 PM, April 1, 2013 to the Bellevue Council
Scholarship Chair at the following address:
Bellevue Council Scholarship Chair
My-Linh Thai
5007 139th Place SE, Bellevue – WA, 98006
Applications that are incomplete, late, or do not follow the guidelines will be disqualified.
All application submission requirements and any attachments, including the required signatures must
be submitted as one package, except that the official transcript may be forwarded by your counselor at
a later date, providing you have the signed and completed transcript request form included in your
application. Incomplete applications will be disqualified.
Questions: please contact: My-Linh Thai, Bellevue PTSA Council Scholarship Chair
(425) 644-6961 Mlinh.thai@gmail.com (Subject: Bellevue PTSA Council Scholarship)
Bellevue PTSA Council Scholarship Application
Page 1
Bellevue PTSA Council
2012-2013 Student Scholarship Application
Submission Checklist and Instructions
The following documents must be secured in a large envelope and postmarked or delivered by 5:00PM
on April 1 to the Scholarship Chair at 5007 139th Place SE, Bellevue – WA, 98006.
For All Scholarships




Application Form – completed and signed.
Activities and Interest Information - typewritten response to interest information requested on the
application form (the Alice Hurd Scholarship requires at least 500 hours of Community Service and for
the Bellevue Parks Scholarship work related to the environment or outdoor recreation should be
emphasized)
Official Transcript – An official copy of the Applicant’s high school transcript that includes first
semester grades
Letter of Recommendation from Faculty or Administrative personnel at Applicant’s school
Additional Information required Individual Scholarships
This information is specific to the scholarships to which the Applicant wishes consideration. The Applicant
will not be considered for a scholarship unless all information required for that specific scholarship is included.
Applicants may apply for multiple scholarships using the same envelope.
Dr. Michael Riley Memorial Scholarship


Essay - Please submit a typewritten essay, limited to no more than one single-spaced page. Select one
of the following essay topics and respond as you deem appropriate.
o Who/What has the greatest impact in your life and why?
o Describe what you hope to achieve in your personal and professional life after college.
Letter of Recommendation from a person in an advisory position outside of the Applicant’s school
Alice Hurd Memorial Scholarship


Essay - Please submit a typewritten essay, limited to no more than one single-spaced page. The topic
must be “Citizenship” and how the qualities of citizenship relate to you. The qualities of citizenship
include social consciousness, positive attitude, responsibility to your community, and the ability to lead
and involve others in a common goal.
Letter of Recommendation from advisor of community service organization or project on which you
have worked regarding your community service activity
Bellevue Parks Scholarship


Essay - Please submit a typewritten essay, limited to no more than one single-spaced page. The essay
must demonstrate the candidate’s passion for the outdoors, and what activity(s) influenced their
awareness of the value of local parks and/or parks recreation programs in Bellevue. The essay must
show a focus on the environment, earth sciences or recreation leadership.
Letter of Recommendation from advisor of organization or project on which you have worked
regarding your commitment to outdoor recreation and nature preservation
Bellevue PTSA Council Scholarship Application
Page 2
Bellevue PTSA Council
2012-2013 Student Scholarship Application
Application Form
Check all Scholarship(s) for which you are applying:
 The Dr. Michael Riley Memorial Scholarship
 The Alice Hurd Memorial Scholarship
 The Bellevue Parks Scholarship
Applicant Data: (Please print clearly or type)
Name: ___________________________________________________________________________
Home Mailing Address: ____________________________________ City: __________
Home Phone: __________________________
Zip: _______
Cell Phone: ________________________________
Email: ________________________________
Parent or Guardian Information:
Parent or Guardian Name: _____________________________________________________________
Mailing Address (if different than above) _________________________ City: ________ Zip: ________
Home Phone: __________________________
Cell Phone: _______________________________
Email: ________________________________
Second Parent or Guardian Name (if different): _____________________________________________
Mailing Address (if different than above) _________________________ City: _______
Home Phone: __________________________
Zip: ________
Cell Phone: ______________________________
Email: ________________________________
Education Information:
Current School: ______________________________________________________________________
University/College/Technical School(s) you have applied for and plan to attend _________________
__________________________________________________________________________________
What field of study do you plan to pursue? _______________________________________________
__________________________________________________________________________________
ALL INFORMATION WILL BE KEPT CONFIDENTIAL
Bellevue PTSA Council Scholarship Application
Page 3
Applicant Interest and Activity Information:
Please concisely answer the following questions. Submissions should be typewritten and included
with your application form.
o Describe your activities/interests in high school (ASB, Music, Sports, Clubs, etc.)
o Describe your activities/interest in the community (include work experiences, volunteer,
place of worship, clubs, etc.)—if applying for the Alice Hurd Scholarship, please include
your community service hours
o List awards, honors, other special achievements
o Describe how further education will affect your future goals
Essay:
Please submit an essay or essays as required for the scholarships to which you are applying. Essays
must be no more than one single-spaced page. Essays should contain a heading including the
applicant’s name, scholarship being applied for and current high school.
Letters of Recommendation:
Please submit two letters of recommendation as required for the scholarships to which you are
applying. Letters of recommendation must be signed, in a sealed envelope and included with your
scholarship application. Make sure that your references include the following information in their
recommendation letters.
Reference # 1 (Faculty or Administrator at Applicant’s High School):
Reference’s Name: __________________________________________________________________
Reference’s Position and or relationship to applicant: _______________________________________
Reference’s Phone Number:
E-mail Address:
Reference # 2 (as required by individual Scholarship):
Reference’s Name:
____________________________________
Reference’s Business & Address: ______________________________________________________
Reference’s Position and or relationship to applicant: _______________________________________
Reference’s Phone Number:
E-mail Address:
If multiple Scholarships are being applied for, please include this information for each reference
on a separate sheet.
Bellevue PTSA Council Scholarship Application
Page 4
Certification:
In submitting this application, I certify that the information provided is complete and accurate to the
best of my knowledge. I give my permission for the contents of this application to be reviewed by the
Scholarship Committee.
I understand that if I am the recipient of the scholarship and I do not use the scholarship money for the
intended purposes (tuition, text books, room and board) by January 1, 2014 OR if I receive a full
scholarship from another source by that date, I shall return the scholarship money and it will remain in
the Bellevue PTSA Council’s Scholarship Fund.
If applicant is over the age of 18, parent’s signature is not required.
Signature of Applicant: ________________________________________________ Date: ________
Signature of Parent/Guardian: __________________________________________ Date: ________
Bellevue PTSA Council Scholarship Application
Page 5