PFLAG NEWScholarshipApplication 2013

Scholarship Application
New Applicant
* Deadline June 1, 2014 *
LGBT persons who: Are 16 years of age or older and have completed high school by June 2014. Have a current permanent home address in or are currently attending a college or university in the Jacksonville metropolitan area (Baker, Clay, Duval, Nassau, and St. Johns counties). Will be registered for full-time attendance (defined as 12 semester hours or more for undergraduate programs and 9 semester hours or more for graduate programs) at a post-secondary educational institution by August 1, 2014. All PFLAG Scholars MUST: Consent to and participate in efforts to educate the general public. Such efforts may entail disclosure of LGBT identity in press releases and other print and visual media. Attend the annual PFLAG Scholarship Ceremony held in August. Submit proof of registration or a letter of acceptance from a post-secondary educational institution for the academic year. Submit grades after the completion of the first academic term. Please note that in order to receive the second installment of scholarship funds, scholars must earn grades of C or higher in all subject areas. At the end of the first academic term, submit a one page typewritten essay OR a 2-3 minute video on what it means to be a PFLAG Scholar. Email to: [email protected] Scholars will be selected using the following criteria: Academic potential and/or evidence of academic achievement of grades C or higher. Evidence of participation and leadership in school and community activity. Clarity of future goals and determination to achieve them. Sense of personal integrity, ethical judgment, and honesty. Maturity and positive sense of self as a lesbian, gay, bisexual, or transgender person. Service to the lesbian, gay, bisexual, and transgender community. Financial need and participation in efforts to supplement educational costs. Note: While preference will be given to full-time students, in some instances parttime students and those enrolled in continuing education programs may be considered. Preference will also be given to applicants who have not previously received a PFLAG scholarship. 1
PFLAG of Jacksonville P.O. Box 2971 Jacksonville, Florida 32203-2971 [email protected] www.pflagjax.org
Revised: 07/13
Who is eligible?
What is required of PFLAG Scholars?
How are PFLAG Scholars chosen?
New Applicant Information

All information will remain strictly confidential
Date: Name: Address: City/State/Zip: Phone: Email address: Post-secondary institution you plan to attend Full Name: Address: City/State/Zip: Current status of admission application: Select Term(s) for which scholarship will be used: Intended major or field of study: Application Checklist
Please complete the checklist below before submitting application package
The application form is complete A current resume is attached Transcripts are attached
Official or unofficial high school transcripts or if applicable your most current official or unofficial post secondary transcripts.
Three (3) reference forms have been distributed

Reference persons may include one family member or friend and should include at least two teachers, school counselors, school administrators, employers, or agency leaders. References should be submitted directly to PFLAG. You are responsible for ensuring that all references are mailed or emailed by the deadline.
I verify that all information is accurate
2
Revised: 07/13
Please answer each of the following questions in essay form using complete sentences and paragraphs. Responses should not exceed a total of five (5) pages with a suggested minimum of two (2) pages. 1. What are your career goals and how do you plan to achieve them?
2.
How has being lesbian, gay, bisexual or transgender affected your life? Describe how you have affirmed your identity as a lesbian, gay, bisexual or transgender person and contributed to the LGBT community.
3.
What achievement or accomplishment has made you especially proud?
4.
What is a book, play or film that has impacted your life? Describe how and why.
5.
Please list what other types of income, including employment and other scholarships, grants, and family and/or friend donations, you plan to pursue in order to finance your education.
____________________________________________________________________________
Remember to complete the Application Checklist on page 2 Save this application and email with other documents to: [email protected] Include PFLAG Scholarship Application in the subject line
*Application materials received after June 1, 2014, will not be considered *

All application materials will be kept on file for three (3) years and then destroyed.
____________________________________________________________________________
3
Revised: 07/13

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PFLAG NEWScholarshipApplication 2013

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Scholarship Application

What is required of PFLAG Scholars?

How are PFLAG Scholars chosen?

New Applicant Information

Three (3) reference forms have been distributed

I verify that all information is accurate

What achievement or accomplishment has made you especially proud?

Application materials received after June 1, 2014, will not be considered

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