WACA Outstanding Student Leadership and Community Service Award

(Revision 9/13/2014)

WACA Outstanding Student Leadership and Community Service Award

Application Form

1.  Date of the Application

Date: ______

2.  Personal Information

First name:______Last Name: ______

Gender: ______DOB: ______

Home Address: ______

Phone Number: Home ______, Cell: ______

Email Address: 1. ______

3.  School Information

Name of High School:______Graduation Year: ______

School Address: ______

Name of Chinese School: ______

Did you graduate from Chinese school?

Yes [ ] Year Graduation:______; HSK Score: ______; AP Chinese Score if any______;

No [ ] when was the last year you attended Chinese School ______

4.  Academics Information

What is your Cumulative GPA:_____ GPA scale: _____ Weighted [ ] Unweighted [ ]

Please attach your up-to-date school transcript

Number of AP classes you have been taking since 9th grade ______

Please provide name of the AP classes, score of AP exam and the grade you took it in:

1.______Score _____Grade ( ) 2.______Score _____Grade ( )

3.______Score _____Grade ( ) 4.______Score _____Grade ( )

5.______Score _____Grade ( ) 6.______Score _____Grade ( )

5.  Standardized Test Scores (attach score report copies)

SAT I Scores: Math______Reading______Writing______Essay______Total______

Date of exam taken______Number of times you have taken the SAT I ______

ACT Scores: Math______Reading______Writing______Science______Essay______Total______

Date of exam taken______Number of times you have taken the ACT______

SAT II Scores: Subject 1: ______Score: ______Date of exam taken______

Subject 2: ______Score: ______Date of exam taken______

6.  Activity Information

List extracurricular activities you participated in since 9th grade: add pages if you need more space

Type of activity.______for example: name of club, science research, etc.

Position/Leadership: ______Hours spent per week ______

Participation grade levels_____ since ______Month/ Year to ______Month/Year

Accomplishments: ______

7.  Community Service (Volunteer)

List all volunteer activities since 9th grade: Please add pages if you need more space

Type of volunteer activity______Your role: ______

Hours spent per week ______Weeks spent per Year ______

From ______Month/ Year to ______Month/Year

8.  Awards

List awards that you earned since 9th grade: Please add pages if you need more space.

Name of award: ______Date of award received:______

Level of the award:

International [ ] National [ ] State [ ] Regional [ ] Local [ ] School [ ]

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