FORMATTING AND FORM INSTRUCTIONS

 

1.        We prefer that you use a computer and Microsoft Word to fill out your application. If necessary, you may use a typewriter or complete the application by hand, writing as legibly as possible, using a blue or black pen.

2.        If you are completing this application by typewriter or by hand, put your answers to Sections A through E directly onto the form. If you are completing it on a computer, fill out the indicated fields, then save and print the file on a high-quality setting. Do not change formatting or the number of pages.

3.        Your responses to the questions in Section F, regardless of what method you use to complete the application, must be placed on separate paper. If using a computer, use a 12-point Times font. Whether using a computer or typewriter, single-space your responses.

4.        Paperclip all pages of your application in sequential order, including the additional pages for Section F. Please DO NOT use any binders or staples.

5.        If you would like submitted materials returned, enclose a self-addressed, stamped envelope or make other arrangements with The Court of Seattle Organization.

 

Your completed application must be postmarked by

Thursday, January 15, 2009

 

Mail to:

Court of Seattle Organization

JC/Lady Graytop Memorial Scholarship Committee

1122 East Pike Street, PMB #1300, Seattle, WA 98122

* NOTE: There is no physical location to drop off applications. They must be mailed.

 

APPLICATION CHECKLIST

Please include:

q    1 original and 5 photocopies of your application, including all attachments.

q    1 original and 5 photocopies of reference letters from two individuals who know your capabilities and potential for success in your educational program.

-  If your references prefer to send letters directly, they must be postmarked by Thursday, January 15, 2009.

q    1 original and 5 photocopies of your transcript from the school you most recently attended.

        -  If your transcript does not reflect your abilities, explain why in your response to Question 12.

        -  If your transcript is being sent separately, make sure it is postmarked by Thursday, January 15, 2009.

MARK YOUR CALENDAR

·      Recipients will be contacted by letter, telephone or e-mail in early January 2008, and invited to attend the awards ceremony at the ISCSORE Coronation Ball, to be held President’s Day Weekend, Saturday, February 14th, 2009, where the scholarships will be announced and certificates of awards will be presented and made public.

The JC/Lady Graytop Memorial Scholarship Application

NOTE:  If you are completing this in Microsoft Word, click on a highlighted field to enter information.
For check boxes, click it once to mark it and a second time to unmark it.

 

SECTION A:  BASIC INFORMATION

 

Your Legal Name:

     

     

 

 

Last

First

Middle Initial

Preferred Name if Different:

      

Mailing Address:

       

City/State/ZIP:

          

County:

     

Permanent Street Address

(if different):

          

City/State/ZIP:

      

County:

     

E-mail Address:

          

Primary Phone:

(   )           

Secondary Phone:

(   )           

 

 

 

 

 

 

 

 

1.       Have you received a JC/Lady Graytop Memorial Scholarship before?        Yes            No

2.       How did you learn about this scholarship? (Please check and describe all that apply.)

  High School Counselor

  Event:            

  College Financial Aid Officer

  Newspaper:            

  Word of Mouth

  Online Site:           

  Poster

  Organization:             

  Other:             

3.       The following information is required to ensure that scholarships reflect the diversity in our community:

Age: 

  

Date of Birth:

     

 

Sexual Orientation: 

 Lesbian

 Gay

 Straight

 Bisexual

 

 Other (Please explain):      

Gender Identity:

 Female

 Male

 Intersex

(Check all that apply)

 Trans

 Trans Female → Male

 Trans Male → Female

 

 Other (Please explain):      

Racial/Ethnic Identity:

     

Do you have a lesbian, gay,

bisexual, or transgender parent? 

 Yes

 No

 Unknown

 

 

 

 

 

 

 

 

 

 

 

 

Your Full Name:

     

     

 

 

Last

First

Middle Initial

SECTION B:  YOUR ELIGIBILITY FOR SCHOLARSHIP

4.       Scholarship Criteria

The JC/Lady Graytop Memorial Scholarship promotes leadership and diversity in the lesbian, gay, bisexual, and transgender (LGBT) community and emphasizes commitment to civil rights for all people. Awards are restricted to residents of Washington.

To help us determine your eligibility for scholarship, please check all boxes that apply.

a.       I am a Washington resident

b.       I have NOT received any four-year college degrees.

c.        I am planning to study and pursue a career in:      

            

            

            

            

            

            

d.       I have a background in leadership activities. (Please elaborate in your response to Question 13)

e.       I plan to pursue leadership activities through college, or pursue national/international excellence in leadership through an accredited institution or program. (Please elaborate in your response to Question 10)

f.         I have a background in participatory athletics. (Please elaborate in your response to Question 13)

g.       I plan to pursue or study participatory athletics through college, or pursue national/international excellence in sports through an accredited institution or program. (Please elaborate in your response to Question 10)

h.       I have a background in civic activities. (Please elaborate in your response to Question 13)

i.         I plan to pursue civic activities through college, or pursue national/international excellence in civics through an accredited institution or program. (Please elaborate in your response to Question 10)

j.         I have a background in community awareness/activism. (Please elaborate in your response to Question 13)

k.        I plan to pursue community awareness/activism through college, or pursue national/international excellence in community awareness/activism through an accredited institution or program. (Please elaborate in your response to Question 10)

Your Full Name:

     

     

 

 

Last

First

Middle Initial

SECTION C:  YOUR EDUCATIONAL BACKGROUND

5.       Please mark the highest year of education completed.

Elementary School       1         2         3         4         5         6         7         8

High School                   9         10      11      12     or             GED

College/University        13      14      15      16     or             Postgraduate Work

6.       Please provide information about each high school, college/university, or other educational institution you have attended.

School Name

City, State

# of

Yrs

Expected

Graduation/

Degree Date

Type of

Degree/

Certificate

Major/

Course of Study

       

     

       

          

     

     

     

     

    

     

     

     

     

     

    

     

     

     

     

     

    

     

     

     

     

     

    

     

     

     

7.       Please check ONE of the two following boxes indicating the status of your transcripts.

   1 original and 5 photocopies of the transcript from my most recent institution are attached.

   My most recent institution is sending my transcripts directly to you.

8.       If you believe that your transcript does not effectively represent your abilities and qualifications, please check the following box and complete Question 12.

   My transcript does not effectively represent my abilities and qualifications. Please see my response to Question 12.

Your Full Name:

     

     

 

 

Last

First

Middle Initial

SECTION D:  YOUR EDUCATIONAL OBJECTIVES

9.       Please provide the following information about the school(s) or program(s) that you will be attending, or are considering attending, during the 2008/2009 school year.

School Name

City, State

Degree/

Certificate

Objective

Planned Major(s) or

Course(s) of Study

Have You

Been

Admitted?

     

                     

     

-      

-      

  Yes

   No

     

     

     

-      

-      

  Yes

  No

     

     

     

-      

-      

  Yes

   No

     

     

     

-      

-      

  Yes

   No

10.   Education and Career Goals:  (Your responses must fit within the space provided)

a. Please describe your educational goals:

     

     

     

     

     

     

     

b. Please describe your career goals and interests:

     

     

     

     

     

     

     

 

Your Full Name:

     

     

 

 

Last

First

Middle Initial

SECTION E:  YOUR FINANCIAL NEED AND RESOURCES

11.   Financial Need

Please use the worksheet below to report and estimate your income and expenses. Generally, your school’s catalog or Web site will provide estimated expenses.

 

A.    KNOWN INCOME

January 2008
thru December 2008

(Estimated)

January 2009
thru December 2009

(Anticipated)

Please name the school you currently attend and/or plan to attend.

          

     

School Name

School Name

 

 

 

   I.       Income from employment (net after taxes)

$           

$           

 

 

 

  II.       Income from partner or spouse

$           

$          

 

 

 

III.       Financial support you currently receive, or expect to receive, from parents/guardians, friends or other family members

$            

$           

 

 

 

IV.       Money you have set aside for your education (including educational IRAs, savings, etc.)

$           

$           

 

 

 

 V.       Income from student loans for the current school year

$           

 

 

 

 

VI.       Have you received, or been notified that you will receive, any educational scholarships or grants?       Yes           No

If yes, please list the names and provide the amounts:

 

 

·         

$           

$           

·         

$           

$           

·         

$           

$           

 

 

 

Enter Total for Each Column Here:

$       

$       

 

 

 

B.    POTENTIAL INCOME

January 2008
thru December 2008

(Estimated)

January 2009
thru December 2009

(Anticipated)

   I.       Have you applied for, or do you plan to apply for, any other scholarships or grants (including Federal Grants) but NOT received notification on them yet?      Yes           No

If yes, list the names and provide the amounts, if available:

 

 

·         

$      

$      

·         

$      

$      

·         

$      

$      

·         

$      

$      

·         

$      

$      

Your Full Name:

     

     

 

 

Last

First

Middle Initial

 

C.    SCHOLARSHIP ELIGIBLE EXPENSES ¹

January 2008
thru December 2008

(Estimated)

January 2009
thru December 2009

(Anticipated)

Please name the school you currently attend and/or plan to attend.

     

     

School Name

School Name

 

 

 

   I.       Tuition and Fees (including labs, facilities, testing, etc.)

$           

$           

 

 

 

  II.       Books and School Supplies

$           

$           

 

 

 

III.       On-Campus Room & Board

$           

$           

 

 

 

Enter Total for Each Column Here:

$      

$      

 

 

 

D.    OTHER EXPENSES ²

January 2008
thru December 2008

(Estimated)

January 2009
thru December 2009

(Anticipated)

          I.      Off-Campus Rent/Mortgage

$           

$           

 

 

 

        II.      Food

$           

$           

 

 

 

       III.      Transportation

$           

$           

 

 

 

      IV.      Personal & Incidental

$           

$           

 

 

 

        V.      Childcare Expense

$           

$