Student Name: ______
Address: ______
Email & Phone: ______
2017 ACHIEVE Scholarship Program
Achieving High Educational Values in Elkhorn
Deadline April 12, 2017
3:30 pm at the Counseling Center
Bronze Level Scholarship: $500.00
Please Note: Applications must be typed to be considered. Please consult with your counselor prior to the deadline to address questions and review the application. Incomplete applications will not be accepted.
AP Coursework:
· List four (year-long) AP courses that you have taken or are taking that you have received an average grade of 3 or better. (Grades will be verified by transcripts which will be attached by the Guidance Counselors).
· Circle year enrolled in each course.
AP Course Year of Enrollment
1. ______9 10 11 12
2. ______9 10 11 12
3. ______9 10 11 12
4. ______9 10 11 12
Elective Coursework:
· List six semesters of elective coursework using no more than two qualifying categories.
· Qualifying categories include coursework in the following subject areas:
Foreign Language Business Physical Education
Music Industrial Technology Family Consumer Science
Art Journalism
· Students will not receive credit for classes required for graduation (e.g. Two PE classes are required for graduation. Therefore, only PE classes taken over the two class minimum will be eligible for this requirement).
· Grades in each course must be a grade of 2 or better. (Grades will be verified by transcripts which will be attached by the Guidance Counselors).
· Circle year(s) enrolled in each course.
Course Name By Semester Category Year of Enrollment
1. ______9 10 11 12
2. ______9 10 11 12
3. ______9 10 11 12
4. ______9 10 11 12
5. ______9 10 11 12
6. ______9 10 11 12
Student Name: ______
2017 ACHIEVE Scholarship Program
Achieving High Educational Values in Elkhorn
Deadline April 12, 2017
3:30 pm at the Counseling Center
Bronze Level Scholarship: $500.00
AP Placement Final Exams:
Applicants must have taken a minimum of two AP Placement Final Exams at the completion of the AP courses.
Name of AP Exam Taken Year Taken
1. ______
2. ______
Extra-Curricular Activity:
· Participate for two years in at least one school-based extra-curricular activity, athletic team, and/or club. (Does not have to be the same activity each year)
Extra-Curricular Activity Year of Enrollment
1. ______9 10 11 12
2. ______9 10 11 12
Community Service:
· Perform a minimum of 50 hours of community service throughout your high school experience.
· Eligible community service includes volunteer hours for the following types of organizations: non-profit organizations, school club, activity group, hospital, retirement center, or religious organization.
· Provide a separate attachment listing your community service hours. The attachment should clearly identify your name at the top of the page and be stapled to the application. Community service information should be provided in the following format:
Date Name of Event/Organization Sponsor/Contact Person Contact Phone Number of Hours
(Note that the Foundation may contact the Sponsor/Contact Person to verify community service hours).
I authorize release of my high school transcript to be included with the ACHIEVE Scholarship application.
______
Student Signature Printed student name
______
High School Counselor Signature Printed counselor name/title
Note: ACHIEVE recipients will wear a special honor cord during the graduation ceremony. Students must enroll at a post-secondary educational institution to receive payment. Instructions will be sent to the students after applications have been verified.
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