ALPA-Gov-Bodies Scholarship Program Application Pt. 3

ALPA Scholarship Application, Part 3

This application must be completed and returned by April 1 to receive consideration.
ALPA Governing Bodies, 7950 Jones Branch Drive, Suite 400S McLean, VA 22102
Questions? Contact GoverningBodies@alpa.org.
Legal Name of Student*

First NameMiddle NameLast Name
Email
NOTE FOR THE PRINCIPAL/GUIDANCE COUNSELOR:

The above-named student is an applicant for a scholarship. To process the application, we need an evaluation and a transcript of the student’s secondary school record. This information will be used only in connection with the selection of the scholarship recipients and will be seen only by qualified persons involved in the selection process.

This form should be signed by the evaluator and endorsed by the principal at the bottom of page 2.
School Name*
City*
State*
Phone*
Name of Principal*

First NameMiddle NameLast Name
Are you confident that the student will receive a school diploma during the current academic year?*

YesNo
Please explain.*
Page 2 includes an evaluation of the student. Who will be performing that evaluation?
Name*

First NameLast Name
Relationship to student*
Length of relationship*
If teacher, please state subject(s)
What size is the community in which your school is located?*

Less than 500500-1,5005,000-25,00025,000-100,000Over 100,000
What economic or social conditions characterize your community or the occupation of most children's parents in your school? (For example, is your community university town, mill town, or farming area?)*

Has this student demonstrated any strong sense of leadership ability?*

YesNo
Please cite specific examples.
Please explain the special circumstances to consider when evaluating this student's achievement record and test scores.*
Secondary School Record: Please attach a copy of the student’s secondary school transcript, including grades 9 through 12. If the transcript is not provided, the applicant will not be considered.*

Cancelof
Secondary School Profile: If your school has a fact sheet or profile, please include it with the student’s transcript. If not, please complete the section on the next page.

Cancelof

The School:
Total enrollment
Size of 12th grade
Independent and off-campus study
Association accredited or approved by
Pattern of school year
Graduation requirements
Other requirements
The Staff:
Number of teaching faculty
Number of college counselors
Method of computing Grade Point Average (GPA) and Rank in Class (RIC)
Advanced Placement (AP) and Honor courses, college study
Provide the school’s policy on reporting class rank
Significant College-Related Instructional Characteristics:
Marking System
Distribution of Scores of Recent 12th Grades on College Entrance Examination Board (CEEB) Test Showing:
Percent of all 12th graders taking tests
Median and range of middle 50% on each of the tests
Signature*

Clear
Title*
Date*

MonthDayYear
Should be Empty:

ALPA Scholarship Application, Part 3

The School:

The Staff:

Significant College-Related Instructional Characteristics:

Distribution of Scores of Recent 12th Grades on College Entrance Examination Board (CEEB) Test Showing: