2021 Mid-Hudson Ivy Foundation Collegiate Scholarship Application

2022 Mid-Hudson Ivy Foundation Collegiate Scholarship Application

SCHOLARSHIP(S) DETAILS
Lorraine M. Petty Roberts Collegiate Scholarship ($2,500)* - awarded to a Poughkeepsie High School student attending a two or four-year college. The recipient should demonstrate a strong commitment to community service exemplifying the spirit of Mrs. Roberts who was a dedicated and committed Poughkeepsie High School teacher for over thirty years. This scholarship renews annually for two or four years. Not available in 2022 - current recipient eligible for renewal.

Betty E. White Collegiate Scholarship ($2,000)* - awarded to a student attending a college or university who has demonstrated academic excellence and sustained community service. As part of the scholarship award program, Ms. White initiated the recognition of community service organizations. She was the executive director of the Cornell Cooperative Extension of Dutchess County.

Book Award ($500) – awarded to 4 students attending a technical school, college or university who have demonstrated sustained community service and academic excellence.

Historically Black Colleges and Universities (HBCU) Scholarship ($500) – awarded to a student attending an Historically Black College or University who has demonstrated sustained community service and academic excellence.

Karen Faulding-Sorlie Memorial Book Award ($500) – established by Mrs. Faulding-Sorlie’s husband. Awarded to a student who participated in the College Admissions Program (#CAP) sponsored by Alpha Kappa Alpha Sorority, Incorporated, Iota Alpha Omega Chapter. Karen’s leadership, energy and enthusiasm were key to the success of chapter high school enrichment programs. The student will have demonstrated #CAP participation, sustained community service and academic excellence.
WHAT MID-HUDSON IVY FOUNDATION SCHOLARSHIP(S) ARE YOU APPLYING FOR? *

Betty E. White Collegiate Scholarship ($2,000) Book Award ($500) Historically Black Colleges and Universities (HBCU) Scholarship ($500) The Karen Faulding-Sorlie Memorial Book Award ($500)
Note: Lorraine M. Petty Roberts Collegiate Scholarship ($2,500) - Not available in 2022 - current recipient eligible for renewal

STUDENT INFORMATION
Date: *

Month Day Year
Date
Name: *

Prefix First Name Last Name
Date of Birth: *

Month Day Year
Date
Address: *

Street Address

Street Address Line 2

City State

Zip Code
Home Number: *

Area Code Phone Number
Cell Number:

Area Code Phone Number
Email: *
example@example.com
Name of High School: *
Guidance Counselor: *
Phone Number *

Area Code Phone Number
GPA: *
Rank: *
SAT Score *
ACT Score: *
List internships and/or ROTC membership, if any: *
Are you employed: *

YES NO
If YES, where? If NO, write N/A:

FAMILY INFORMATION
Name of Parent(s)/Guardian(s): *
Number of children in family: *
Ages: *
Number of children who will be attending college next year: *

FUTURE PLANS
Briefly describe your higher education and/or vocational goals: *

0/50
Please list the name of the University/College you plan to attend: *
Area of Study: *

ESSAY/PERSONAL STATEMENT
Please select one of the topics of below and write a 250 word essay.
- What do you consider to be the single most important societal problem? Why?
- Pick an experience from your own life and explain how it has influenced your development.
- Describe your career goals and your plan to achieve them.
*

0/250

ESTIMATED UNIVERSITY/COLLEGE COSTS
*This section is required for the Betty E. White & Lorraine M. Petty Roberts Collegiate Scholarship applicants ONLY. If you are not applying for this scholarship please write N/A in the required fields.
How do you plan to pay for your college/post–secondary expenses? *
What are your estimated tuition expenses? *
Please list the scholarships/award money you have already received from colleges and or private scholarships: *

RECOMMENDATIONS
Please list TWO (2) people who will be completing letters of recommendation attesting to your academic standing, volunteerism, work ethic and character. The letters may be written by a School Counselor, Supervisor, Advisor, Coach, Scout Master or Church official. Each letter must be on letterhead with the Recommender’s signature.
Reference Name: *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Reference Name: *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number

RESUME
Please upload a pdf. file format of your most up to date resume by clicking on the button below. Resumes should include Community Service and/or Extracurricular Activities/ Work/ Clubs/ Sports)
*

Browse Files

Cancel of

MEDIA WAIVER FORM
Please upload your signed media waiver form below.
*

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Cancel of
2022 COLLEGIATE SCHOLARSHIP

APPLICATION CHECKLIST
• Please be sure to attach the following items when submitting your application otherwise your application will be incomplete and not considered.

✓ An official transcript

✓ A Student Resume (please include Community Service and/or Extracurricular Activities/ Work/ Clubs/ Sports)

✓ Essay

✓ Media Waiver

• Please review the application to be sure you have answered every question clearly.

• Please check spelling and grammar.
Please be sure to mail the following materials:

Two (2) letters of recommendation An official transcript
Application materials must be mailed to:

MHIF-AKA Collegiate Scholarships

P.O. Box 1848

Poughkeepsie, NY 12601
Your application materials must be postmarked or submitted online by April 1, 2022. Before submitting, please review your application one more time before submitting.
Should be Empty:

2022 COLLEGIATE SCHOLARSHIP