FWC 2014 College Scholarship Application Checklist
APPLICATION INSTRUCTIONS
Please complete the application and return it with the following items via email to
arobertson@wedchild.org or to the address listed below postmarked by the deadline of Friday,
July 18, 2014:
Copy of your unofficial high school transcript or a copy of your GED certificate
One letter of recommendation by a teacher, foster parent, caseworker, or mentor
A 500 word essay covering area of study, plans for your future and reasons to be
selected for the scholarship
Acceptance letter to school of choice
3 Page Friends of Wednesday’s Child Scholarship Application
Friends of Wednesday’s Child Scholarship Program Acknowledgement Agreement
Friends of Wednesday’s Child Authorization & Consent for the Disclosure of Information
Friends of Wednesday’s Child PAL College Scholarship Referral Form
PLEASE NOTE: INCOMPLETE PACKAGES WILL NOT BE CONSIDERED.
ALL APPLICANTS WHO HAVE SUMBITTED APPLICATIONS WILL BE INFORMED OF THEIR
STATUS NO LATER THAN THURSDAY JULY 31ST.
MAIL APPLICATIONS TO:
Friends of Wednesday’s Child
Scholarship Application
Attn: Alisha Robertson
2801 Swiss Avenue Suite 130
Dallas, TX 75204
Selected scholarship recipients must submit a copy of their unofficial transcript every semester
to show their grades from their last semester (must show cumulative GPA) and their schedule
for their next semester. In addition, each year while receiving the scholarship there will be
additional checkpoint documents required (one per semester). If documents are not submitted
as required your scholarship disbursement could be delayed or suspended. FWC staff is
available to assist you with questions you may have about the college application and financial
aid process. We look forward to being a resource for you! Please call 972.231.1433 ext. 204 for
assistance.
FWC 2014 College Scholarship Application
Please complete the enclosed application and return it to FWC postmarked by the deadline of
Friday July 18, 2014. Feel free to attach additional paper if you need more room to write.
Name:
SSN #:
Originating County:
Email:
Address:
City:
Zip:
Phone: Home:
Cell:
Preferred #: ☐Home ☐Cell
Birthdate:
Age:
Ethnicity:
Gender:
Current School:
GPA:
School Type (Please check the appropriate response):
Number of High Schools Attended:
☐
Public ☐ Charter ☐ Magnet ☐ Private
Number of Middle Schools:
Affiliations (Please indicate if you were referred by any of the following):
☐
Agency
☐ CPS Caseworker
☐ PAL
Date When You Entered Care: Month:
☐ Other
Year:
Will you be participating in Extended Foster Care? ☐ Yes
Age at time:
☐ No
Approximate number of placement changes since entering care:
Length of time at current placement:
Caregiver:
Phone:
Email:
CPS Worker:
Phone:
Email:
Type of Institution You Will Be Attending:
4 Year College
2 Year Community College
Trade School
Other (please specify):
Address of School:
Financial Aid Office Contact:
Applicant Will Attend School: ☐ Full Time ☐ Part Time
Enrollment Date:
Area of Study:
Type Degree/Certification Sought:
Projected Graduation Date:
List any Scholarships for which you have applied or plan to apply other than
FWC:
Name of Scholarship:
Date Applied:
Name of Scholarship:
Date Applied:
Name of Scholarship:
Date Applied:
Name of Scholarship:
Date Applied:
Standardized Test Scores: If you have taken either or both the SAT and the ACT please
record your most recent scores below. If you have not taken these tests, please leave blank.
SAT Scores:
Math
Critical Reading
ACT Scores:
Math
Reading
Written
Science
Cumulative
English
Composite
List any honors or awards you have received:
Name of the Award
Area (Service, Athletics, Academic, Other)
Date Received
Please list your work history below
Company
Position
(if applicable):
Dates of
Employment
Average #
hours/week
List any extracurricular activities (inside or outside of school) in which you have
participated (e.g., sports, clubs, band, volunteer groups, student government, church, caring
for family members):
Name of Club
or
Organization
Title and Role
Years of Involvement
Total
9th 10th 11th 12th Years
Hours/
Week
Weeks/
Year
ESSAY
On a separate sheet of paper, please type your 500 word essay.
Essay topic:
Write about your area of study, your plans for the future and the reasons why you
should be selected for this scholarship.
Friends of Wednesday’s Child 2014 Scholarship
Program Acknowledgement Agreement
(Please Sign and Return this page)
I,
, understand that all future communication relating to
Student Name
my application will be conducted via email. It is my responsibility to provide a current
email address that I will check on a weekly basis, or more frequently, so as to remain
current with the application process. If I move or change contact information, I must
immediately notify Friends of Wednesday’s Child with my updated contact information
(phone number and email address). I understand that I must continue to meet all the
deadlines in order to remain in good standing with my scholarship. In addition, I agree to
perform and/or be bound by the following obligations:
1. I will maintain a 2.0 cumulative grade point average, on a 4.0 scale, or its
equivalent in a non-standardized grading system.
2. I will remain a full or part time student while receiving this scholarship and if I fail
to do so I understand my scholarship can be revoked. Full-time scholarships are
$1000 per semester and part-time scholarships are $500 per semester.
3. I sign this release allowing the school to send FWC information on each term
including, but not limited to: transcripts, schedules, and financial status.
4. I will inform FWC immediately if I am placed on academic probation.
I acknowledge and understand that if I fail to perform or abide by these obligations, my
scholarship provided by Friends of Wednesday’s Child may either be delayed or
terminated.
Student Signature:
Date:
Friends of Wednesday’s Child Authorization &
Consent for the Disclosure of Information
Student:
SSN:
DOB:
School Address:
I hereby authorize and request that the following infomration with regard to my record
be provided to:
Friends of Wednesday’s Child
2801 Swiss Avenue, Ste.130
Dallas, Texas 75204
972-231-1433, Fax #972-231-3422
Primary Contact at FWC: Alisha Robertson, Mission Manager
I understand that the inform,ation will be given to FWC to assist in their process for
providing my scholarship. The information provided wil be limited to the follownig
specific types of information:
 Grade Reports
 Class Schedules
 Financial information including other scholarship/grant monies and balance due
The consent is subject to revocation by the undersigned at any time, and if not earlier
revoked, shall terminate upon graduation from this institution.
Student’s Signature
Date
Friends of Wednesday’s Child PAL College
Scholarship Referral Form
Completed applications are due by July 18, 2014. Please submit the PAL referral with
your completed application by the deadline.
Fax Number: 972.231.3422
Email: arobertson@wedchild.org
Student Information:
Student’s Name:
Student’s Email:
Phone: Home:
Birthdate:
Preferred #: ☐Home ☐Cell
Cell:
Cumulative GPA (9th-12th):
Current School:
Eligibility Requirements (must meet all):
1. This student originated in Region 3.
2. The student is planning to attend a 2 year community college or 4 year university
beginning Fall 2014.
3. The student is currently earning a cumulative GPA of 2.0 or higher.
4. This student has completed the PAL program.
PAL Staff Member Information:
PAL Staff Member Name:
Phone:
Email Address:
Thank you for your referral to Friends of Wednesday’s Child College Scholarship
Program.
Signature of PAL Staff Member
Date