2023-24 Academy Scholarship Application

Scholarship Application
Application Submission Deadline:

Monday, July 10, 2023
Name*

First NameLast Name
Position/Title*
District*
School
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Site Profile
Level

ElementaryMiddle/Jr. HSHigh SchoolK-12Other
Surrounding Community*

RuralSuburbanUrban
ADA

Ethnic Mix (%)

	Click to edit
American Indian/Alaskan Native
African American
Asian or Pacific Islander
Filipino
Hispanic
White
Other

District Profile
Level

ElementaryMiddle/Jr. HSHigh SchoolK-12Other
Surrounding Community*

RuralSuburbanUrban
ADA

Ethnic Mix (%)

	Click to edit
American Indian/Alaskan Native
African American
Asian or Pacific Islander
Filipino
Hispanic
White
Other

ACSA's policy does not allow discrimination against applicants or participants on the basis of race, religion, sex, national origin, color or handicap. Indicating the following is optional:
MaleFemale
African AmericanAmerican Indian/Alaskan NativeAsian or Pacific IslanderFilipinoHispanicWhiteOther

Eligibility Criteria
Highest priority will be given to ACSA members whose applications are complete, thorough and address as many of the following criteria as possible:
1. Is a regular ACSA member
2. Commitment to the profession
3. Demonstrates contribution to the profession
4. Culturally, ethically or linguistically diverse
5. Has experience working in an urban or rural environment
6. Shares ACSA’s mission and beliefs
7. Has an interest in understanding and influencing education policy
8. Currently provides leadership that enlists and engages others in their professional work setting
9. Has not previously been awarded an ACSA Academy scholarship
Essay
In the space available below, address each of the four sections listed and, as appropriate to each section, include discussion of each of the eligibility criteria that are applicable to you (limit of 500 words per section).
A. Discuss your present position and career goals and the ways that you provide leadership in your professional work setting and within the ACSA organization.*
B. Discuss how attendance at this ACSA academy will enhance your contribution to education.*
C. Describe your involvement with ACSA at the state, region and charter levels.*
D. Specify the circumstances of your financial need. Carefully explain your financial need and the efforts you have made to obtain funding through other sources.*
Application Checklist
Please submit all of the following materials by the application deadline:

Completed Academy registration form without remitting Academy registration fee (limit of one application per member)Completed Scholarship Application Form (all sections)Copy of up-to-date résumé
Upload Completed 2-Page Registration Form*

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Upload Resume*

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Do not include additonal materials or letters of recommendation.
Recipients are responsible for all expenses above the scholarship amount.
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