Lawton Scholarship Application

1
Name* This field is required.
First Name
Middle Name
Last Name
2
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Student Birth Date* This field is required.
Date
Month
Day
Year
4
Student Phone Number* This field is required.
Area Code
Phone Number
5
Student Email* This field is required.
example@example.com
6
Parent/ Guardian Name * This field is required.
First Name
Last Name
7
Parent Phone Number* This field is required.
Area Code
Phone Number
8
Parent/ Guardian Email* This field is required.
example@example.com
9
Are you currently an American Citizen?* This field is required.NOTE: Legal permanent resident status does NOT qualify. Applicant MUST be a citizen on the date the application is signed.
YESNO
10
Naturalization Details* This field is required.If you were not born an American Citizen, but are a Naturalized American Citizen, give date, place (Office or Court where Naturalization occurred) and Naturalization Number. If Naturalized under the Child Citizenship Act of 2000, please include your parent(s) naturalization information.
Office or Court where Naturalization Occured
Naturalization Number
Date of Naturalization
If you were not born in the United States, but are a citizen by birth, explain circumstances in this section
11
Are you currently a Citizen of Greene County?* This field is required.NOTE: Legal permanent resident status does NOT qualify. Applicant MUST be a citizen on the date the application is signed.
YESNO
12
I am graduating high school senior currently enrolled at* This field is required.
GCHS
LOA
NGA
13
Previous or current enrollment in or completion of which ATLAS program:* This field is required.
Atlas After School Program
Greene Co. Christian Learning Center
THRIVE
Other
14
Prospective recipients must be planning to enroll full-time in the upcoming academic year at either an accredited two- or four-year degree-granting institution in the United States.
College you plan to attend
Degree
Pathways(s) Completed
Certification(s) Earned
Please Select
Please Select
Yes
No
Have you been accepted to this college as of this application date?
Career plans at this time
15
Job History* This field is required.List any jobs you have held while in high school, starting with the most recent. Include any jobs or work-based learning/apprenticeships, even if you were not paid. Complete this section, and if necessary, attach a separate sheet. List the average hours worked per week.
Employeer
Job Title
Please Select
Please Select
Yes
No
Related to Career Goals
Please Select
Please Select
Yes
No
Work Based Learning
Average Hours Per Week
16
Dates of Service* This field is required.
17
Do You Have Additional Job History to Add?* This field is required.
YESNO
18
Job History* This field is required.List any jobs you have held while in high school, starting with the most recent. Include any jobs or work-based learning/apprenticeships, even if you were not paid. Complete this section, and if necessary, attach a separate sheet. List the average hours worked per week.
Employeer
Job Title
Please Select
Please Select
Yes
No
Related to Career Goals
Please Select
Please Select
Yes
No
Work Based Learning
Average Hours Per Week
19
Dates of Service* This field is required.
20
Job History* This field is required.List any jobs you have held while in high school, starting with the most recent. Include any jobs or work-based learning/apprenticeships, even if you were not paid. Complete this section, and if necessary, attach a separate sheet. List the average hours worked per week.
Employeer
Job Title
Please Select
Please Select
Yes
No
Related to Career Goals
Please Select
Please Select
Yes
No
Work Based Learning
Average Hours Per Week
21
Do You Have Additional Job History to Add?* This field is required.
YESNO
22
Job History* This field is required.List any jobs you have held while in high school, starting with the most recent. Include any jobs or work-based learning/apprenticeships, even if you were not paid. Complete this section, and if necessary, attach a separate sheet. List the average hours worked per week.
Employeer
Job Title
Please Select
Please Select
Yes
No
Related to Career Goals
Please Select
Please Select
Yes
No
Work Based Learning
Average Hours Per Week
23
Job History* This field is required.List any jobs you have held while in high school, starting with the most recent. Include any jobs or work-based learning/apprenticeships, even if you were not paid. Complete this section, and if necessary, attach a separate sheet. List the average hours worked per week.
Employeer
Job Title
Please Select
Please Select
Yes
No
Related to Career Goals
Please Select
Please Select
Yes
No
Work Based Learning
Average Hours Per Week
24
Dates of Service* This field is required.
25
Do You Have Additional Job History to Add?* This field is required.
YESNO
26
Job History* This field is required.List any jobs you have held while in high school, starting with the most recent. Include any jobs or work-based learning/apprenticeships, even if you were not paid. Complete this section, and if necessary, attach a separate sheet. List the average hours worked per week.
Employeer
Job Title
Please Select
Please Select
Yes
No
Related to Career Goals
Please Select
Please Select
Yes
No
Work Based Learning
Average Hours Per Week
27
Dates of Service* This field is required.
28
Do You Have Additional Job History to Add?* This field is required.
YESNO
29
Job History* This field is required.List any jobs you have held while in high school, starting with the most recent. Include any jobs or work-based learning/apprenticeships, even if you were not paid. Complete this section, and if necessary, attach a separate sheet. List the average hours worked per week.
Employeer
Job Title
Please Select
Please Select
Yes
No
Related to Career Goals
Please Select
Please Select
Yes
No
Work Based Learning
Average Hours Per Week
30
Dates of Service* This field is required.
31
Do You Have Additional Job History to Add?* This field is required.
YESNO
32
* This field is required.List community service and extracurricular activities in which you have been involved while in high school, starting with the most recent. List the total hours for each opportunity and circle whether the opportunity is related to your overall career goals. NOTE: When listing Community Service activities, please focus on the opportunities in which you participated multiple times or over a period of time.
Business, Company, Event or Activity
Specific Service or Type of Work
Hours Served Per Week
Please Select
Please Select
Yes
No
Related to Career Goals
33
Dates of Service* This field is required.
34
Add More Community Service & Extracurricular Activities* This field is required.
YESNO
35
* This field is required.List community service and extracurricular activities in which you have been involved while in high school, starting with the most recent. List the total hours for each opportunity and circle whether the opportunity is related to your overall career goals. NOTE: When listing Community Service activities, please focus on the opportunities in which you participated multiple times or over a period of time.
Business, Company, Event or Activity
Specific Service or Type of Work
Hours Served Per Week
Please Select
Please Select
Yes
No
Related to Career Goals
36
Dates of Service* This field is required.
37
Add More Community Service & Extracurricular Activities* This field is required.
YESNO
38
* This field is required.List community service and extracurricular activities in which you have been involved while in high school, starting with the most recent. List the total hours for each opportunity and circle whether the opportunity is related to your overall career goals. NOTE: When listing Community Service activities, please focus on the opportunities in which you participated multiple times or over a period of time.
Business, Company, Event or Activity
Specific Service or Type of Work
Hours Served Per Week
Please Select
Please Select
Yes
No
Related to Career Goals
39
Dates of Service* This field is required.
40
Add More Community Service & Extracurricular Activities* This field is required.
YESNO
41
* This field is required.List community service and extracurricular activities in which you have been involved while in high school, starting with the most recent. List the total hours for each opportunity and circle whether the opportunity is related to your overall career goals. NOTE: When listing Community Service activities, please focus on the opportunities in which you participated multiple times or over a period of time.
Business, Company, Event or Activity
Specific Service or Type of Work
Hours Served Per Week
Please Select
Please Select
Yes
No
Related to Career Goals
42
Dates of Service* This field is required.
43
Add More Community Service & Extracurricular Activities* This field is required.
YESNO
44
* This field is required.List community service and extracurricular activities in which you have been involved while in high school, starting with the most recent. List the total hours for each opportunity and circle whether the opportunity is related to your overall career goals. NOTE: When listing Community Service activities, please focus on the opportunities in which you participated multiple times or over a period of time.
Business, Company, Event or Activity
Specific Service or Type of Work
Hours Served Per Week
Please Select
Please Select
Yes
No
Related to Career Goals
45
Dates of Service* This field is required.
46
Add More Community Service & Extracurricular Activities* This field is required.
YESNO
47
* This field is required.List scholastic and civic/community honors and awards received during grades 9 through 12. Check the grade in which the honor/award was received; state the name of the honor/award, and check the level of recognition. Please write the full name of the award or certification (do not use abbreviations). Use an attachment to this application if necessary.
Honor / Award / Certificate
9th
10th
11th
12th
Grade Level
School
State / Regional
National
Level of Recognition
48
Add Additional Awards, Honors, Certificates? * This field is required.
YESNO
49
* This field is required.List scholastic and civic/community honors and awards received during grades 9 through 12. Check the grade in which the honor/award was received; state the name of the honor/award, and check the level of recognition. Please write the full name of the award or certification (do not use abbreviations). Use an attachment to this application if necessary.
Honor / Award / Certificate
9th
10th
11th
12th
Grade Level
School
State / Regional
National
Level of Recognition
50
Add Additional Awards, Honors, Certificates? * This field is required.
YESNO
51
* This field is required.List scholastic and civic/community honors and awards received during grades 9 through 12. Check the grade in which the honor/award was received; state the name of the honor/award, and check the level of recognition. Please write the full name of the award or certification (do not use abbreviations). Use an attachment to this application if necessary.
Honor / Award / Certificate
9th
10th
11th
12th
Grade Level
School
State / Regional
National
Level of Recognition
52
Add Additional Awards, Honors, Certificates? * This field is required.
YESNO
53
* This field is required.List scholastic and civic/community honors and awards received during grades 9 through 12. Check the grade in which the honor/award was received; state the name of the honor/award, and check the level of recognition. Please write the full name of the award or certification (do not use abbreviations). Use an attachment to this application if necessary.
Honor / Award / Certificate
9th
10th
11th
12th
Grade Level
Please Select
Please Select
School
State / Regional
National
Level of Recognition
54
Add Additional Awards, Honors, Certificates? * This field is required.
YESNO
55
* This field is required.List scholastic and civic/community honors and awards received during grades 9 through 12. Check the grade in which the honor/award was received; state the name of the honor/award, and check the level of recognition. Please write the full name of the award or certification (do not use abbreviations). Use an attachment to this application if necessary.
Honor / Award / Certificate
9th
10th
11th
12th
Grade Level
Please Select
Please Select
School
State / Regional
National
Level of Recognition
56
Add Additional Awards, Honors, Certificates? * This field is required.
YESNO
57
* This field is required.List scholastic and civic/community honors and awards received during grades 9 through 12. Check the grade in which the honor/award was received; state the name of the honor/award, and check the level of recognition. Please write the full name of the award or certification (do not use abbreviations). Use an attachment to this application if necessary.
Honor, Award, or Certification
9th
10th
11th
12th
Grade Level
Please Select
Please Select
School
State / Regional
National
Level of Recognition
58
Add Additional Awards, Honors, Certificates? * This field is required.
YESNO
59
* This field is required.List your principal leadership roles in the order of importance to you. State the name of the activity or organization in which you were a leader; the years you were involved; hours-per-week commitment; and the position/leadership role/responsibilities held in that role. Examples include, but are not limited to, student government, yearbook, debate, orchestra/band, varsity athletics, church groups, performing arts, clubs, service clubs, etc.
Leadership Position
Activity
Hours Per Week
9th
10th
11th
12th
Grade Level
Please Select
Please Select
School
County
State
National
Level of Recognition
60
Add Additional Leadership Positions / Honors / Letters Earned?* This field is required.
YESNO
61
* This field is required.List your principal leadership roles in the order of importance to you. State the name of the activity or organization in which you were a leader; the years you were involved; hours-per-week commitment; and the position/leadership role/responsibilities held in that role. Examples include, but are not limited to, student government, yearbook, debate, orchestra/band, varsity athletics, church groups, performing arts, clubs, service clubs, etc.
Leadership Position
Activity
Hours Per Week
9th
10th
11th
12th
Grade Level
School
County
State
National
Level of Recognition
62
Add Additional Leadership Positions / Honors / Letters Earned?* This field is required.
YESNO
63
* This field is required.List your principal leadership roles in the order of importance to you. State the name of the activity or organization in which you were a leader; the years you were involved; hours-per-week commitment; and the position/leadership role/responsibilities held in that role. Examples include, but are not limited to, student government, yearbook, debate, orchestra/band, varsity athletics, church groups, performing arts, clubs, service clubs, etc.
Leadership Position
Activity
Hours Per Week
9th
10th
11th
12th
Grade Level
School
County
State
National
Level of Recognition
64
Add Additional Leadership Positions / Honors / Letters Earned?* This field is required.
YESNO
65
* This field is required.List your principal leadership roles in the order of importance to you. State the name of the activity or organization in which you were a leader; the years you were involved; hours-per-week commitment; and the position/leadership role/responsibilities held in that role. Examples include, but are not limited to, student government, yearbook, debate, orchestra/band, varsity athletics, church groups, performing arts, clubs, service clubs, etc.
Leadership Position
Activity
Hours Per Week
9th
10th
11th
12th
Grade Level
School
County
State
National
Level of Recognition
66
Add Additional Leadership Positions / Honors / Letters Earned?* This field is required.
YESNO
67
* This field is required.List your principal leadership roles in the order of importance to you. State the name of the activity or organization in which you were a leader; the years you were involved; hours-per-week commitment; and the position/leadership role/responsibilities held in that role. Examples include, but are not limited to, student government, yearbook, debate, orchestra/band, varsity athletics, church groups, performing arts, clubs, service clubs, etc.
Activity
Hours Per Week
9th
10th
11th
12th
Grade Level
School
County
State
National
Level of Recognition
68
Add Additional Leadership Positions / Honors / Letters Earned?* This field is required.
YESNO
69
* This field is required.List your principal leadership roles in the order of importance to you. State the name of the activity or organization in which you were a leader; the years you were involved; hours-per-week commitment; and the position/leadership role/responsibilities held in that role. Examples include, but are not limited to, student government, yearbook, debate, orchestra/band, varsity athletics, church groups, performing arts, clubs, service clubs, etc.
Activity
Hours Per Week
9th
10th
11th
12th
Grade Level
School
County
State
National
Level of Recognition
70
Add Additional Leadership Positions / Honors / Letters Earned?* This field is required.
YESNO
71
* This field is required.List your principal leadership roles in the order of importance to you. State the name of the activity or organization in which you were a leader; the years you were involved; hours-per-week commitment; and the position/leadership role/responsibilities held in that role. Examples include, but are not limited to, student government, yearbook, debate, orchestra/band, varsity athletics, church groups, performing arts, clubs, service clubs, etc.
Activity
Hours Per Week
9th
10th
11th
12th
Grade Level
School
County
State
National
Level of Recognition
72
Add Additional Leadership Positions / Honors / Letters Earned?* This field is required.
YESNO
73
Essay* This field is required. Directions: In the following area, answer the following question: Using one of the leadership roles, extracurricular activities, for class experiences you prioritize as being important to you, describe the following; the impact the experience had on you; what you contributed to the role, activity or experience; what you learned about yourself; and, how it has influenced your plans for the future.
Huge
Large
Normal
Small
Ok
Ok
74
ATLAS Reflection * This field is required. Directions: In the following area, give your best answers to the question on each page. Use only the space provided, so be concise and clear in your answers. Reflection: Write a brief paragraph about your relationship with ATLAS Ministry and the impact it has made on you. How long have you been associated with ATLAS in what way(s)? What is something in particular that you learned that makes a difference to you now?
Huge
Large
Normal
Small
Ok
Ok
75
Counselors Name* This field is required.
First Name
Last Name
76
Counselors Email* This field is required.
example@example.com
77
Signature* This field is required.To sign using a traditional mouse, hold down the left-click button on your mouse and sign your name. If you are using a tablet or a touchscreen, use your finger to sign.
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