Application for Scholarship

The Cultural Crossroads scholarship ($500.00) is available to all senior high school students in Jackson County, Missouri, who are enrolled or about to be enrolled in a public institution of higher education (i.e., a state or county university or community college, but not a for-profit institution) in a degree or vocational program, and who demonstrate an awareness of cultural competency and a desire to promote peace and justice.

The application form follows. Please fill it out completely and submit to Cultural Crossroads.

Remember that there are no incorrect answers – we simply want to learn about you and your plans.

We wish you good fortune, both with this application and with your future plans.

Application deadline is February 1. Application may be submitted

· Online (fill in and click Submit button)

· OR print copy and send

o By email to CulturalCrossroads@hotmail.com

o By mail to Cultural Crossroads, Inc., 3605 Blue Ridge Blvd, Independence, MO 64052

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Area CodePhone Number

Age at Last birthday

Date of Birth

High School attended

Higher education institution

Date of enrollment

If student is under the age of 18 years, list parent/guardian

Email of parent/guardian

example@example.com

Degree/program

Please attach a copy of your "unofficial" transcript or send as a separate pdf form. If your high school was less than perfect, please tell us what issues, if any, you faced.

Grade point average:

What honors have you received in high school?

Extra-curricular activities in high school, if any:

Does your school offer community service opportunities?

If so, how many hours of service did you perform last year?

How many hours in previous years?

Have you volunteered with any nonprofit organizations?

If so, which ones and for how many hours?

What do you hope to achieve by enrolling in higher education (i.e., past high school)?

What do you think is the greatest challenge facing our society at this time?

How do you think you will address that challenge?

PRIMARY ESSAY: In 300-500 words, please describe your "ideal" society and how you believe you can make a different in the world to realize that ideal, by focusing on the issue of youth violence and YOUR idea(s) to alleviate that issue. (Add or upload another page, if needed.)

0/200

CONFIRMATION:

By submitting this form, I confirm that the information provided on the application is true and correct, and I understand that including any knowingly false information automatically disqualifies me from eligibility. If I earn the scholarship for which I am submitting this application, I give permission for my name and photo to be used in publications.

APPLICATION FOR SCHOLARSHIP