The Calvert Scholarship

Application Form
Directions
To apply for the Calvert Scholarship,an applicantmust do three things. First, complete this form. If the space provided is insufficient, attach any additional information on a separate page. Second, attach a copy of your high school transcript. Third, describe your experiences, abilities, and goals in a manner you think will be helpful in assessing the factors listed below. The description may be organized as an essay or otherwise, according to your desires—that is, non-conventional forms of expression are fine. There is no minimum or maximum length. Any other information, materials, or letters of recommendation addressing the factors below are welcome, but are not required. Applicants not submitting additional materials or letters of recommendation will not be disadvantaged by the lack of such materials.All materials must be mailed or delivered to The Calvert Scholarship Committee, at 515 Canary Lane, Carterville, IL 62918 on or beforeFriday, March 29, 2013. If you would like additional information, you may contact the Committee by sending an email to
The Committee may consider the following factors, among others, in awarding the scholarship:
(1) academic accomplishment; (2) participation in extra-curricular activities; (3) participation in community affairs, hobbies, or any other activity outside of school; (4) potential for success in college; (5) the applicant’s character and potential for success in life; (6) the likely impact of the scholarship on the future academic achievements of the applicant; (7) recommendations from teachers or members of the community. The Committee encourages individuals who do not plan to attend an institution of higher education immediately following graduation to apply for the scholarship. The Committee does not discriminateagainst individuals on the basis of race, color, religious affiliation or lack thereof, sex or gender, sexual orientation, disability, or national or ethnic origin.
Basic Information
Name
First Last
Home Address
Number and Street
City and State / Zip Code
Date of Birth / Age / Telephone
Academic Information
1. If you took the ACT or SAT test, what scores did you receive? If you took a test more than once, you need only list the higher score. You are encouraged to provide documentation of your score.
ACT: / SAT:
2. If you plan to attend an institution of higher learning in the next year, to which schools have you applied or do you plan to apply? If there is not room on this form, please attach the names of other institutions to which you are applying on a separate sheet of paper. Please list the schools in order of your preference for attending the school should you be accepted. If you have decided where you will attend, please explain.
School Name / Have you been admitted?
5. If you do not plan to attend an institution of higher learning in the next year, briefly describe your plans below. You should describe your plans in more detail in your application essay.
6. Please list your activities in the community (including employment) below. You are encouraged explain those activities in more detail in your application essay.
Organization and Activity / Approximate hours per week
Verification and Permission for Release of Records
I affirm that I am presently a senior at Carterville High School and will graduate in 2013.
I affirm that the information contained herein is true and accurate to the best of my knowledge and belief.
I hereby grant permission to officials of CartervilleHigh School and Unit 5 School District to release my academic record and other information the Calvert Scholarship Committee may request. I understand that this application and other information provided will be available only to members of the Calvert Scholarship Committee.
Signature / Date
Calvert Scholarship Application 2013 / Page 1 of 2