Arkansas State Society Daughters of the American Revolution
Mary Deere, Arkansas State Regent
=============================================
Arkansas DAR Scholarship Committee----Annette Rawls, Chairman, 2014-2016
510 Highway 114, Rison, AR 71665-9641
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Cover Sheet for Arkansas DAR Scholarship Applications
ARKANSAS DAR SCHOLARSHIPS INCLUDE THE STEVENSON- WESTBROOKE SCHOLARSHIP
($1000), THE FRANCES LOYD-JANE CHESSHIR SCHOLARSHIP ($500) and 2 ARKANSAS DAR
SCHOLARSHIPS ($1000 each)
(All applicants use the same forms)
NAME OF APPLICANT________________________________________________
Name of High School ________________________________Telephone: __________
Address of High School__________________________________________________
SPONSORED BY: Chapter _______________________________________City _______________
___________________________________________________________________________________
Chapter Regent / telephone / e-mail
_________________________________________________________________________________
Chapter Scholarship Chairman / telephone / e-mail
_____________________________________________________________________________________
Address
_____________________________________________________________________________________
City, State, Zip Code
_______________________________________________
Date Submitted**
*Sponsoring DAR Chapter must submit a letter of recommendation for each applicant.
**Deadline for submitting application to the State Chairman is January 20. It must be submitted by
the sponsoring DAR Chapter Regent or Chapter Scholarship Chairman.
Revised July 2014
Arkansas State Society DAR Scholarship Application
Name of Student:_________________________________________ Telephone:________________________
Permanent Address:_____________________________________________________________________
Name/Address of High School_______________________________________________________________________
Class Rank/Class Size __________________
Cumulative GPA (4.0 Scale):_____________
(Must be in upper third of class)
Test Scores:
SAT (min. 1100)
(minimum 3.0)
__________
ACT (min. 22) __________
College or University you plan to attend ___________________________________________________________
College Address: _______________________________________________________________________________
Selected Major: _______________________________________________________________________________
___________________________________________________________________________________________________________________________
Instructions: The application package must be complete and arranged in the order described below.
Typewritten application and statements are preferred. Do NOT submit a personal photograph. This
Scholarship is judged and awarded without regard to gender, race, color, religion, national origin or
disability.
1. LETTER FROM SPONSORING DAR CHAPTER.
2. Scholarship Application (this page).
3. Financial Need Form. Attach the front page of parents’ income tax form stating their AGI (adjusted
gross income).
4. Applicant must prepare a typed statement setting forth his/her career objectives, specifying how college
major or college plans relate to future professional goals, and stating reasons for these choices. Maximum 2
pages on one side of 8 ½ x 11” paper.
5. Official transcript of high school grades. High school transcript must indicate class rank/class size,
cumulative GPA on a 4.0 scale, and ACT or SAT scores. Home schooled students include grade transcripts
for grades 9 through the current year.
6. List extra-curricular activities, honors received, scholastic achievements, employment and / or jobs held,
volunteer and / or community service activities, and other significant accomplishments. Maximum 2 pages
on one side of 8 ½ x 11” paper.
7. Two dated, signed letters of recommendation: (1) one from the school principal or counselor and (2) one
from an employer or character reference (not from relatives). The letters may cover the applicant’s ability,
work habits, integrity, and potential.
8. Photocopy of United States Citizenship: photocopy of birth certificate, naturalization papers, or
information page of U.S. Passport. Note: Temporarily cover the photograph if photocopying naturalization
or passport pages.
9. Application package should be stapled or paper-clipped in the top, left hand corner.
10. Return the complete application packet to the following Arkansas DAR Chapter Chairman:
_____________________________________
Revised July 2014
deadline:
_____________________
Arkansas State Society DAR Scholarship Application
Financial Need Form
(Do not leave blanks).
FATHER/STEPFATHER/GUARDIAN:
MOTHER/STEPMOTHER/GUARDIAN:
Name________________________________
Name_______________________________
Address______________________________
Address_____________________________
_____________________________________
____________________________________
Employer_____________________________
Employer____________________________
Position______________________________
Position ____________________________
Annual Income $_______________________
Annual Income $_____________________
Other sources of income or financial aid: ____________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Names and ages of dependent children (note those who may be attending college at the same time as
applicant):
_____________________________________________________________________________________
_____________________________________________________________________________________
The parent/guardian shall prepare a statement summarizing the family’s obligations and resources. The
statement needs to illustrate the applicant’s need for financial assistance. Statement follows (use back if
necessary):
I attest that all information in this application and all attachments are a true and accurate record:
___________________________
Signature of Father/Stepfather/Guardian
Revised July 2014
____________________________
Signature of Mother/Stepmother/Guardian
________________________
Signature of Applicant