Community ~ Scholarship ~ Social Service
An engaged women’s network actively participating in and supporting our community through
scholastic and social services.
2015 High School Scholarship Application
Dear High School Senior,
Bexley Women’s Club supports our community each year by providing $1,000 scholarships to
graduating high school seniors who are legal residents of Bexley with a GPA of at least 2.5.
Recipients are selected anonymously based on merit and financial need.
Please complete pages 2 through 6 and return them along with your essay page via the
Bexley High School counselor or US post office by Tuesday, March 24, 2015. You may
retain the first page of the application for your records. Scholarship recipients will be determined
in May. If you would like written verification of your status, please include a self-addressed,
stamped #10 envelope with your application. Any scholarship award made must be used for the
2015-2016 academic year, (GAP students are not eligible).
Please note that the completed application consists of six pages (pages 2-6) plus the essay
page. Do not use forms from prior years as changes have been made to the application. Your
answers must be legible and your essay must be typed in Times New Roman font size 12. If
you are awarded a scholarship, it will be your responsibility to provide enrollment
verification before the award can be finalized and a check issued. Should you have
additional questions, please e-mail Natalie Coles, Chair of the Bexley Women’s Club
Scholarship Committee at NRColes58@yahoo.com.
On behalf of all Bexley Women’s Club members, thank you for your participation in the
scholarship program. We wish you all the best as you actively pursue your educational goals.
Warm Regards,
Natalie R. Coles, Chair
Scholarship Committee
Bexley Women’s Club
Disclaimer: The scholastic department retains the right to verify any information
provided by a scholarship applicant. Scholarship applicants are eligible to receive a
scholarship from Bexley Women’s Club only once. A scholarship recipient who is not
enrolled in an accredited college or university for the fall term following receipt of
his or her scholarship award shall forfeit said scholarship. In the event the eligible
student population has been expanded beyond high school seniors, a recipient subject
to forfeiture shall be eligible to submit an application for a subsequent award.
Personal Information
(This page will be retained by your school counselor)
Student Number: _______________________
Full Name: __________________________________________________________
Address: ____________________________________________________________
____________________________________________________________________
Email Address: _______________________________________________________
Phone Number: Home: _________________________Mobile:__________________
Parent/Guardian Name(s):_______________________________________________
Parent/Guardian Address(s): *If different from yours
_____________________________________________________________________
_____________________________________________________________________
Parent/Guardian Phone Number(s):
Home: ________________________________ Mobile: _________________________
Home: _________________________________Mobile:_________________________
Media Release
Bexley Women’s Club is proud of our Scholarship Recipients. We send press releases to
various media for non-commercial and non-profit purposes. Although ability to publicize names
and photos of recipients does not affect our scholarship decisions, we would like your
permission to publicize your name and photo if you are selected as one of our recipients. If you
will not be 18 years of age by May 1st, a parent or guardian must sign for consent.
____ Yes, you have my permission to publicize my name and photograph.
____ No, please do not publish my name and photograph.
Volunteer Interest
If awarded a BWC Scholarship, (and your schedule permits) which activity will you plan to
participate in?
______July 4th Parade (Ride in the scholarship car and pass out candy)
*Event Date July 4, 2015
______The BWC House and Garden Tour (Work a shift in the scholarship house)
*Event date June 7, 2015
Student Signature: ______________________________________________________
Parent/Guardian Signature: _______________________________________________
Disclaimer: The scholastic department retains the right to verify any information
provided by a scholarship applicant. Scholarship applicants are eligible to receive a
scholarship from Bexley Women’s Club only once. A scholarship recipient who is not
enrolled in an accredited college or university for the fall term following receipt of
his or her scholarship award shall forfeit said scholarship. In the event the eligible
student population has been expanded beyond high school seniors, a recipient subject
to forfeiture shall be eligible to submit an application for a subsequent award.
Application
(Information supplied will be verified for accuracy)
Student #__________________________
(15pts.)
Academic
Cumulative GPA ______/______ (Please list GPA Scale exp.: 3.4/5 or 3.0/4)
To which colleges or universities have you applied?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
List the colleges or universities from which you have received letters of acceptance.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
State your intended course of study, (major and/or minor or undecided).
_________________________________________________________________
(15pts.) Activities
List extra-curricular activities in which you have been involved and the years which you
participated.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
(10pts.) Honors
List all honors received in high school, (both academic and non-academic) and the years in
which they were awarded. Be certain to list all leadership roles, (examples include music,
athletics, community service, team captain, employee of the month, etc.).
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(15pts.) Community Service
List all community service activities and the years in which you were involved.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(30pts.) Financial Need
*Detail of point structure is in parenthesis
Have you submitted the FAFSA form with the College Scholarship Service?
Yes______________
No_________________ (3 of 30pts)
Are you eligible for a Pell Grant?
Yes______________
No__________________ (2 of 30pts)
List all scholarships, grants and/or loans for which you have applied. Indicate those which you
have received, regardless of school choice. (5 of 30pts)
Scholarship/Grant/Loan
Amount Per Year Awarded
If you have selected a school to attend and have been offered scholarship support from that
school please specify the details:
___________________________________________________________________________
Will you have paid employment while enrolled in college?
Yes____________ No___________ Not Sure__________
List any work experience during the last 4 years including summer employment. (15pts)
Dates
Employer
Job Title
Hours Per Week
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Will you be a first generation college student? _______________ (5pts)
(15pts.) Essay
On a separate piece of paper, briefly list your personal, professional and long term goals. Be
certain to detail what your plan to reach your goals is and what role education plays in achieving
your future goals. Include any information you would like us to consider regarding your financial
situation. The essay must be one page and typed in Times New Roman 12 point font. Pay close
attention to sentence structure and grammar.