Aqua Foundation for Women


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	AFW Scholarship Application

All information is strictly confidential.

Eligibility: You must be a resident of Broward or Miami Dade County and have a history of leadership in the Lesbian, Bisexual and Transgender community and plan to be a LBT leader in the future.

Instructions: You must follow all instructions for your application to be considered. See the checklist below before mailing the application as incomplete applications cannot be considered.

» Completed and signed application with essay attached.
» Attached photo, this will not be returned. Photocopies are not acceptable.
» Most recent academic transcript to be sent by school or in sealed envelope.
» At least two and no more than three letters of recommendation. At least 1 of these must be from an individual familiar with your work in the LBT community.
» A photocopy of Driver’s License/State Issued ID (6 months prior proves residency).

Application Deadline: March 1, 2008

First Name:

Last Name:

Address:

City

State:

Zip

Phone Number

1. Are you a graduating high school senior?		Yes No
2. Date of birth
3. Ethnicity/Race
4. Do you self identify as an LBT woman?		Yes No
5. If yes, are you ‘out and open’ in the community?		Yes No
6. Are you a supporter of the LBT Community?		Yes No
APPLICANT’S ACADEMIC STATUS
8. Name of High School: (Skip to question 15 if you are a high school graduate)

Address:

City			State:
Zip

9. Name of Financial Aid Advisor:
Phone Number
10. Name of Principal
Phone Number
11. Are you in good academic standing?		Yes No
12. GPA
Approximate Class Rank
Number in class
13. Have you been awarded any school honors or recognitions?		Yes No
If so, please list them:
14. What school clubs or extracurricular activities are you involved with?
APPLICANT’S FINANCIAL NEEDS AND COLLEGE INFORMATION
15. If you are LBT, are your parents aware of your LBT status?		Yes No
16. If you are LBT, are your parents supportive of your LBT status?		Yes No
17. Do you live apart from your family?		Yes No
18. Do you support yourself financially?		Yes No
19. Do you believe that you have any special needs?		Yes No
If yes, please explain your needs on a separate sheet of paper. These special needs will be treated with confidentiality. If we need to contact anyone else about these needs, we will contact you first to obtain your permission to talk with others about your needs.
20. To what colleges are you applying?
21. What is your admission status?		Planning to apply Waiting for school to respond Admitted

22. Estimated annual college cost (tuition, room and board, books, etc)
23. Do you have a chosen major?		Yes No
If yes, list chosen major:
24. How do you plan to finance your college education? (check all that apply)
Student loans		Grants or scholarships
Part-time employment		College work/study program
Full-time employment
25. Are your parents able and willing to assist with your college expenses?		Yes No
IF YOUR PARENT (S) ARE SUPPORTIVE, AND WILLING AND ABLE TO ASSIST WITH YOUR COLLEGE EXPENSES, PLEASE ANSWER THE FOLLOWING QUESTIONS: (SKIP TO NEXT SECTION IF THIS DOES NOT APPLY TO YOUR SITUATION)
26. Is this a single parent family?		Yes No
1st parent’s first name:
1st parent’s last name:
2nd parent’s first name:
2nd parent’s last name:
27. If both parents reside at the same address, are they both working?		Yes No
28. Total household income as reported on 2006 federal tax return(s)
29. Total number of exemptions claimed on tax return(s)
30. Number of dependent children in the household
31. Number of dependent children in college
APPLICANT’S COMMUNITY SERVICE INVOLVEMENT AND/OR ANY EMPLOYMENT HISTORY

32. Please briefly describe any community service activities with which you have been involved. You should describe only those activities which have been of the highest importance to you. You do not have to describe every activity that you have undertaken. Be sure to mention any activities in which you have played a leadership role and ANY activities in the LBT community.
33. What jobs, if any, have you held? Please list both volunteer and paid positions as appropriate:
Employer’s Name
Job Title
Dates of Employment

Employer’s Name
Job Title
Dates of Employment

Employer’s Name
Job Title
Dates of Employment

ADDITIONAL QUESTIONS:
34. Please describe any achievements of which you are especially proud:
35. What are your post-college plans?
ESSAY QUESTIONS:
1. What are your interests, hobbies, or extracurricular activities? Choose one and tell how it has affected your life.
2. What would you like to be doing five years from now? How do you plan to achieve this?
3. If applicable, how has the fact that you are lesbian, bisexual, or transgendered affected your life?
4. If you are chosen for an award, how would receiving these funds from AFW allow for your greater participation in the LBT community?
5. Is there anything else you would like to tell us?
6. Please upload a compressed file (.zip), including: » Recent Photo » At least two references, one of which from an individual familiar with your LBT community work » Photo copy of Drivers License or State ID card (6 months prior proves residency)