2016-2017 SOMERSET HIGH SCHOOL LOCAL SCHOLARSHIP APPLICATION

This application should be returned to the high school counseling office by the end of the day on

Friday, March 3. Typed applications are required. This template is available on the school’s website under counseling office; scholarships. You may only use the space provided. Please do not use your name or family names in responses. You will be scored on spelling, grammar, and sentence structure as well as the thoughts expressed.

Please include a letter of recommendation, from someone not involved in the school (not a teacher, coach, or counselor). Letters should not be written by family members or relatives.

Attached is the rubric to assist you when writing your responses.




Component 1 (5 points)

Component 2 (5 points)

How have you been preparing for this career? Please include courses you have taken in high school as well as any additional experiences you have had, such as volunteer work in the field, internships, or mentorships.

Any employment experiences should also be included.

Component 3 (15 points)

Describe any service activities you engaged in during high school (including approximate amount of time you spent doing them) and how they impacted you. Include leadership roles you held. Please respond in the space provided.

Component 4 (10 points)

Please list below all high school activities you have been involved in, the leadership roles you held, and the amount of time/years you participated in them.

Component 5 (30 points)

Please address ONE of the topics below. You may only use the space provided.

1.Describe how you demonstrated leadership during the past twoyears.

2.Select one experience from your life and explain how it influencedyou.

3.How have you been a good rolemodel?

4.Describe your most meaningful achievement or accomplishment. (This could be in or out ofschool.)

5.Describe someone you admire (either living or deceased) and how his or her personal qualitiesinfluence you and yourcharacter.

Component 7 (5 points)

What is your ACTscore?

Somerset Memorial Scholarship Fund Photo Release Form

I hereby give my consent to the Somerset Memorial Scholarship Fund to photograph, film, videotape and then use, reproduce, and publish said images of me.


(Please print student name)


Student signature


(Please print parent’s name)


Parent’s signature