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AFW Scholarship Application
  All information is strictly confidential. This authorization is being granted to this AFW Committee as it pertains to my being considered for a AFW Family of Scholarships Award.

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 Extended: March 31, 2009
  I authorize the members of the Aqua Foundation for Women (AFW) Family of Scholarships Committee to review and discuss my grades and other records concerning me that are maintained by my school or submitted by me for consideration.  This authorization is being granted to this AFW Committee as it pertains to my being considered for a AFW Family of Scholarships Award.
 
Student's Authorization Yes No


First Name:
      
Last Name:
     
Address:
      
     
City
  State:    
Zip
      
Email
      
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 graduated high school student)
  
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? If you are currently in college, what is the name of your current institution and what is the cumulative GPA?
     
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
      
       
34. Please describe any achievements of which you are especially proud:
     
ESSAY QUESTIONS:
       
1. What career do you plan to pursue upon completion of your education? How have your past experiences shaped this goal? (500 word limit)
      
2. If applicable, how has the fact that you are lesbian, bisexual, or transgendered affected your life? How would being a recipient of this reward allow you to make a positive contribution to the LBT community? (400 word limit)      
3. Optional Essay: Complete this essay if there is other information you would like to add regarding your candidacy. For instance, if you believe one or more aspects of your application (e.g., GPA or test scores) do(es) not accurately reflect your potential for success (300 word limit)
     
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)

      
CERTIFICATION:
I attest that all the information contained in my application is factually correct and honestly presented. The Aqua Foundation for Women has my permission to verify information submitted in this application. I understand that any misrepresentation of my application will justify the denial or cancellation of any offer of scholarship by the AFW.
Yes No