Horizonte Instruction and Training Center
2014-2015 Scholarship Application
Adult
Centro Civico
DSP
Evening
ESL-Adult
Highland
Main St.
ISP
Odyssey
Rose Park
South City
Other
1.
Name in full:
2.
Mailing Address:
3.
Day Phone:
4.
Name and address of a post-secondary school (college) to which you have submitted an application:
Last
First
Street
Middle
City
State
Zip Code
Phone after 5:00 P.M.
Name in full:
Address:
Street
City
State
Zip Code
5.
Proposed area of study
6.
State what plans you have after your high school education is completed:
7.
Please list activities (work, community, school-related…) in which you participated while attending Horizonte
Instruction and Training Center program. (Attach an additional sheet if necessary)
8.
Write a personal essay one page (double spaced) on the challenges you have overcome in getting your high school
diploma or educational goals in the future. (Attach an additional sheet)
Student’s signature:
Date:
Advisory teacher’s name & signature
College Checklist:
I have applied to and been accepted at ___________________________________________ (proof of enrollment required)
Test Scores will support my field of study. Please include proof of applicable score:
ACT _________
SAT _________
Accuplacer: Math 1010________ English 1010_______ TABE_________ (tech only)
1234 South Main Street, SLC, Utah 84101
Phone: 801-578-8574 - Fax: 801-578-8382
Last Name: ___________________ First Name: _______________ Program: ________________ Credits needed for graduation: _____
In which Horizonte Instruction and Training Center program are you enrolled? Please check one.
Horizonte Instruction and Training Center
2014-2015 Scholarship Application
January 6, 2015
I agree to the following provisions for the Horizonte Scholarship:
1. I will use the assistance awarded me by the Horizonte Scholarship Fund (HSF) for school year 2015-16
(funds must be allocated by December 15, 2015).
2. I will provide a written thank you to the Scholarship Fund.
3. I understand I must receive a Horizonte Instruction and Training Center High School Diploma by July 31,
2015, in order to be eligible for the Horizonte Fund scholarship.
4. I will participate in the Horizonte/Salt Lake Community College (SLCC) Pathways Spring 2015 College
Preparation class.
5. I will develop a post high school plan with my advisor and consult with my mentor if I need to make
adjustments to that plan.
6. If attending SLCC, I will consider participation in the Pathways SLCC navigation and mentor program
which provides personal assistance to new college students.
7. In accordance with Horizonte Scholarship Fund rules and FERPA, I authorize
_____________________________ (name of College) to release academic information (including records
related to grades, disciplinary proceedings, tuition, fees and financial aid) to Horizonte. This release shall
remain in effect until revoked by me, in writing.
I accept these provisions. I understand that if I do not meet these requirements, I forfeit HSF assistance.
___________________________________________________________________________________________
Scholarship Applicant Signature
Date
___________________________________________________________________________________________
Parent/Guardian Signature (if 18 or under)
Date
VIDEO RELEASE
I authorize Horizonte to create a video interview about my experiences. I give my permission for this video to be
used by the media to promote awareness and continue to raise funds for future Horizonte students.
___________________________________________________________________________________________
Student Signature
Date
___________________________________________________________________________________________
Parent Signature (if student is under 18)
Date
***Application is due February 28, 2015
1234 South Main Street, SLC, Utah 84101
Phone: 801-578-8574 - Fax: 801-578-8382