LIBBY BURR LEADERSHIP & ACADEMIC

5TH REGION SCHOLARSHIP APPLICATION

GENERAL INFORMATION

5th Region is happy to announce the availability of a scholarship, an award to a deserving cheerleader. Each applicant must show evidence of outstanding academic ability and leadership. The scholarship is offered as an honor scholarship emphasizing scholarship and leadership. In order to qualify for this scholarship, the applicant must be a member in good standing in the KAPOS association.

The accepted applicant may apply for admission to the college or university of his or her choice, provided it is a Kentucky Institute.

SCHOLARSHIP ELIGIBILITY AND PROCEDURE

Please read the following information carefully to insure that you will be able to receive full consideration by the Committee on Scholarships.

  1. All Scholarship Applicants MUST:
  2. Complete carefully all parts of this application.

Please type or fill out in ink. All information will be treated as confidential.

  1. Take the ACT (American College Testing) or the SAT (Scholarship

Aptitude Test).

  1. Obtain letters of recommendation from the cheerleader sponsor

And the school principal. The character of the applicant must be above reproach.

  1. Submit completed application, transcript, test results, and letters of

Recommendation from principal and sponsor by October 21. Incomplete applications and applications received after this date will not be considered.

  1. Submit a photograph with application.
  2. Submit in your own handwriting why you feel you are qualified for this scholarship.
  1. All Scholarship Applicants should:
  2. Rank in the top 15 percent of their graduating class.
  3. Have a minimum composite score of 20 on the ACT and/or have a minimum composite score of 900 on the SAT.
  4. The high school counselor or principal must submit section V of this

application.

  1. The recipient of the scholarship will be announced at our Region-At-Large competition.
  2. APPLICANTS MUST RETURN THIS FORM AND LETTERS OF RECOMMENDATION TO:

JOELLA NALL

1863 ST. JOHN CHURCH ROAD

RINEYVILLE, KY 40162

  1. PERSONAL INFORMATION
  1. Name ______

(Last) First) (Middle)

  1. Home address______

(street)

______

(City) (State) (zip code)

  1. Home Phone ______
  1. Name and address of local newspaper and TV station

______

  1. How long have you been a varsity cheerleader?______
  1. EDUCATION INFORMATION
  1. High School ______

Graduation date ______

  1. List any recognition or honors received in high school.
  1. List your most significant extra-curricular school activities and any non-school activities.
  1. COLLEGE PLANS
  1. Have you applied for admission to any college or university

in Kentucky? If so, which one?______

When do you plan to enter?______

Do you plan to work for a degree at the institution?______

If not, what are your plans?

  1. have you applied for any other scholarships?______

If so, please list.

  1. If you have selected your profession or occupation, indicate it

herewith______

  1. INFORMATION CONCERNING FAMILY AND RESOURCES
  2. Family

a. Father’s name ______living ( ) deceased ( )

name of employer______

nature of business______

position held______

  1. Mother’s name______living () deceased()

Name of employer______

  1. Number of children in addition to applicant______

Pre-school______Elementary school ______high school______

College ______If in college, where?______

Financially independent, married, etc. ______

State below as specifically as possible how you plan to finance your freshmen year including loans, part time work, summer employment, etc.

______

Signature of applicant

Section V must be completed by the high school counselor or principal

  1. ACADEMIC INFORMATION
  1. Total number in graduating class ______

Applicant’s rank ______

  1. ACT test results

Standard scores

______

Eng. Math Soc. Sc. N. Sc. Comp

3. SAT test results ______

Verbal Math

  1. Overall grade point standing ______
  1. Attach copy of high school transcript.

______Signature of counselor or principal