10th
5th Annual William F. King Jr. Scholarship
Annual William F. King Scholarship
Chevron Corporation Black History Awareness Scholarship
Chevron Richmond Black History Awareness Scholarship
Letter of Recommendation Form
2015 Application
Student Profile
Please Print
Name:
Email Address:
Date of Birth: ___________________________________________
Gender:
□ Female
□ Male
Home Address:
City:
Phone Number: (
State:
Zip:
)
High School Name:
Address:
City:
State:
Are you a child or dependent of a current Chevron employee?
Zip:
□ Yes* □ No
(* Children of current Chevron employees and/or contractors are not eligible for this scholarship)
How did you hear about this scholarship?
□ College Counselor □ Academic Advisor □ Other (please specify) ________________________
Which colleges or universities are you interested in attending in 2015? (List your top 3 choices):
1)
State: _______
2)
State: _______
3)
State: _______
1of 4
Extracurricular & Community Service Profile
Describe your leadership activities and experiences:
hrs/wk #-wks/yr
1.
2.
3.
4.
5.
Describe your community involvement and extracurricular activities:
hrs/wk #-wks/yr
1.
2.
3.
4.
5.
Essay
Write a 500-750 word essay on ONE of the following two topics. Write your name and essay topic number in the top left corner of the essay. Attach your double spaced,
typed essay to your application. Essays will be judged on content, originality, creativity, grammar, and punctuation. Note: Scholarship Recipients’ are not eligible
to receive more than one Diversity Chevron Sponsored Scholarship.
2of 4
1. How has African American and/or African Diaspora culture affected your life, your families’ life, or someone else’s life?
2. What lesson or event in African American and/or African Diaspora culture will you use to enrich your future?
3. How has the African American and/or African Diaspora culture enhanced your leadership skills within your community,
include your community contributions.
Essay
Write a 500-750 word essay on ONE of the following two topics. Write your name and essay topic number in the top left corner of the essay. Attach your double spaced,
typed essay to your application. Essays will be judged on content, originality, creativity, grammar, and punctuation. Note: Scholarship Recipients’ are not eligible
to receive more than one Diversity Chevron Sponsored Scholarship.
4. How has African American and/or African Diaspora culture affected your life, your families’ life, or someone else’s life?
5. What lesson or event in African American and/or African Diaspora culture will you use to enrich your future?
6. How has the African American and/or African Diaspora culture enhanced your leadership skills within your community,
include your community contributions.
Required Letter of Recommendation
Include a reference letter from your teacher, coach, community leader, pastor, etc. that references your leadership, community
involvement, and extracurricular activities. Provide attached “Letter of Recommendation” form (page 4) to your recommender.
GPA Disclosure
I hereby certify the information provided in this application is, to the best of my knowledge, true and correct. I authorize the
Scholarship Committee to have access to my school file to validate my GPA. Please have your school counselor or registrar
sign the application to verify the validity of your GPA, > 2.5.
Cumulative G.P.A.:
Student Signature
Date
Counselor or Registrar’s Signature
Date
Mailing & Deadline Information
All application components must be mailed in one package and must be postmarked on or before January 10, 2014 Late or
incomplete applications will not be considered.
Please consult your college counselor or advisor for submission directions. You may either submit your application to your
College Counselor/Advisor, or email it directly to:
RichmondCE@chevron.com
Chevron Corporation
Black History Awareness Essay Contest
Attn: Michael R. Adams
100 Chevron Way, Bldg. 71-7534
Richmond, CA 94801
Winner Notification – Fourth Week of January 2015
3of 4
APPLICATION CHECKLIST
The student is responsible for submitting all materials on time. Incomplete applications will not be
evaluated. This application becomes complete and valid only when the scholarship committee has received
all of the following materials:




Student Application
Essay
Letter of Recommendation
GPA Verification
Postmarked on or before
December 19, 2014
4of 4
10th Annual William F. King Jr. Scholarship
Chevron Richmond Black History Awareness Scholarship
Letter of Recommendation Form
(Provide this form to your recommender)
Applicant’s Name ______________________________________________________________
Instructions to Applicant
You must provide a current, confidential letter of recommendation. The letter may be from an instructor, advisor, coach, community leader,
pastor, etc. The letter cannot be from a relative. You should fully apprise your recommender about the William F. King Scholarship and your
reasons for applying. Allow your recommender at least two weeks to write the letter. Submit the sealed recommendation with your
application by the December 19, 2014 postmark deadline.
Instructions to Applicant’s Recommender
The person named above is applying for a William F. King scholarship. This scholarship is administered by Chevron’s Richmond Black
Employee’s network. Please type your letter of recommendation on letterhead stationery of your professional or organizational affiliation.
We request your candid, written evaluation of the applicant relative to the following:
o
o
o
o
Academic record
Academic plans and career goals
Personal strengths, including motivation, leadership, and commitment
Community service and extracurricular activities
The scholarship review committee will use your observations as part of its selection process. The applicant will benefit most from a specific
and illustrative evaluation rather than a general assessment. The evaluation should discuss the applicant's strengths and, as appropriate,
provide insight to any areas for growth. Please share what criteria you base your judgment upon and how the applicant meets those
principles.
Please complete the information below and return this form and your signed letter of recommendation to the student in a sealed envelope.
The scholarship committee appreciates your assistance.
Recommender's name __________________________________________________________________ Date ______________________
Professional title ______________________________ Professional/Organizational Affiliation _____________________________________
Address ________________________________________________________________________________________________________
City _________________________________________________________________ State _________ Zip code ___________________
E-mail _________________________________________________________________ Phone (
) _________________________
How long have you known the applicant? ______________________ In what capacity? _________________________________________
5of 4