DATE 12 January 2015

Senior Guidance Counselor

SUBJ: THE DUVAL HOUSE NEW BEGINNING SCHOLARSHIP for $500.00.
OPEN: January 12, 2015 April 04, 2015

SENIOR GUIDANCE COUNSELORS, PLEASE POST FOR ALL

SENIORS PLANNING TO ATTEND A 2 YEAR COLLEGE OR A
FOUR YEAR UNIVERSITY.
The scholarship is any student who will begin the summer or fall term of
2015. All required information must be included or the application will
be disqualified. The application has to be typed, completed on the
computer, or printed neatly in ink. An application written in pencil will
be disqualified. The application must be sent in by 4 April 2015, a late
application will be disqualified.
Scholarship winner or representative will be required to attend the 2015
awards banquet to receive their scholarship.
FURTHER, INFORMATION REGARDING THE 22 MAY 2015,
SCHOLARSHIP AWARDS BANQUET, WILL BE GIVEN TO THE
WINNERS.
FOR ADDITIONAL INFORMATION REGARDING THE SCHOLARSHIP CALL:
Retired (LCDR) Washington, Herlena Scholarship Chairperson, 696-5565 home or 904-382-5627 cell,
or Co-Chairperson - Jackie Bartletto 904-778-1459 - home.
THERE WILL BE A FREE BANQUET FOR SELECTED RECIPIENTS AND FAMILY MEMBERS
ARE ENCOURAGED TO ATTEND.

THE DUVAL HOUSE NEW BEGINNING SCHOLARSHIP APPLICATION

The application must be completely filled out. Use additional sheets of unlined paper as needed.
You are responsible for ensuring that your transcripts and SAT or ACT scores are forwarded to the
following address 13565 Ashford Wood Ct E. Jacksonville, FL 32218. The address is also listed on the
final page of this application.
Please complete all seven parts of this application. Incomplete or illegible applications will
not be considered. Place your name in the top right comer of each page of your submitted
application.
(Please Type or Print all information)
1. BACKGROUND
Name (Last, first, middle initial) -_______________________________________________
Address: ______________________________________________________________________
City: ______________________________

State: _______________ Zip: _______________

Telephone Number: ________________________ Social Security Number: xxx -xx- ________

Email address _____________________________
Date of Birth: _______________

Sex: ________

High School: ____________________________________________________

Counselor: ________________________________ Telephone: __________________________
Your Grade Point Average: ____________________ (4.0 Scale)

SAT Scores: Verbal ______________

or

ACT Scores: English ___________

Math ______________

Math _____________

2. GOAL SETTING AND ACHIEVEMENT

a. What field of study do you plan to pursue in college?
________________________________________________________________
b.

List at least 2, two year colleges or four year universities to which you have applied.
___________________________________

_______________________________

THE DUVAL HOUSE NEW BEGINNING SCHOLARSHIP APPLICATION

3.

EXPRESSIVENESS: Write a (1) page paper describing yourself and your goals. Include in the
paper suggestions you would give to the president for 2015 for health care, education, gun violence,
and how to stimulate the economy in order to increase jobs for the American people. (Please attach
with the application) .

4.

EXTRACURRICULAR AND COMMUNITY ACTIVITIES:

a. NEATNESS COUNTS. Please type or print all information on a separate sheet of paper with
the heading:
"EXTRACURRICULAR AND COMMUNITY ACTIVITIES".
b.

Desired Format: (see below)

ORGANIZATION
EXAMPLE:
I. Beta Club
2. Beta Club
3. Beta Club
4. School Ensemble
5. Border Babies
etc:
5.

POSITION
HELD
Member
Secretary
President
Member
Member

DURATION
(Mo/Yr-Mo/Yr)
10/99-7/01
8/00-7/01
9/99-8/00
10/98-5/00
8/00-7/01

DESCRIBE
YOUR ACTIVITY
Academic Honors Club
Academic Honors Club
Academic Honors Club
Singer
Clinic Assistant

WORK EXPERIENCE
a. NEATNESS COUNTS. Please type or print all information on a separate sheet of paper
with the heading:
"WORK EXPERIENCE
b. List all jobs for each school year, even if you worked the same job in a previous school
year. For the purpose of this application, the school year runs from 01 August until 31
July of the next year.
c. Desired Format: (see below):
COMPANY
EXAMPLE:

DURATION (Mo/Yr-Mo/Yr)

YOUR JOB DESCRIPTION

1. Peoples Drug Store

10/99-01/00

Stock Person

2. McDonalds Restaurant
02/00-12/00
THE DUVAL HOUSE NEW BEGINNING SCHOLARSHIP APPLICATION

Cashier

6. AWARDS AND ACHIEVEMENTS:

a. NEATNESS COUNTS: Please type or print all information on a separate sheet
of paper with the heading:
AWARDS AND ACHIEVEMENTS
b. List all recognition received for each school year, even if you received the same
recognition in a previous school. For the purpose of this application, the school year runs
from 01 August until 31 July of the next year.
c.

Desired Format: (see below)

DESCRIPTION OF RECOGNTION

DATE RECEIVED

EXAMPLE
1. Sportsmanship Award for Track and Field
2. Outstanding Student Award
3. Outstanding Student Award
etc:

6/00
6/00
6/01

7. INCLUDE WITH YOUR APPLICATION:

-

One copy of your high school transcript through the senior year fall semester.
Copy of SAT or ACT scores.
At least three letters of recommendation (one must be from a counselor OR teacher at
YOUR school.)
Any college letters of acceptance you may have received.

All information provided must be true and accurate to the best of the applicants knowledge. Sign here to
confirm this statement: _________________________ Date: _________________________
A BRIEF INTERVIEW may follow if you are selected. An awards Banquet will be held 22 May
2015 for recipients. Only applicant winners will be notified by phone. Return this application and
required documents NOT LATER THAN 04 April 2015 to:
Retired LCDR Herlena O. Washington
ATTN: Scholarship Committee Chairman
13565 Ashford Wood Ct E.
Jacksonville, FL 32218