Inspiring Young Minds ☼ Educating Tomorrow’s Leaders
Scholarship application type:
a) Academic merit
or
b) Cultural merit
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Application deadline September 1, 2016
APPLICANT
First Name
Middle Name
Last Name
_______________________________________________________________________________
Home Address
_______________________________________________________________________________
City
State
Zip Code
_______________________________________________________________________________
Tel. #
E-mail
_______________________________________________________________________________
Date and place of birth
(city, state & country)
sex:
_______________________________________________________________________________
Citizenship Status:
□ U.S. Citizen
□ U.S. Permanent Resident
Is a Language other than English spoken at home? □ Yes □ No
If yes, please specify: ____________________________________________________
1200 Palm Harbor Pkwy-Palm Coast, FL 32137
Tel. (386) 446-3910
www.PalmCoastPortugueseClub.com
[email protected]
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PARENT’S INFORMATION
Father’s full name and place of birth
(city, state, and country)
________________________________________________________________________
Mother’s full maiden name and place of birth
(city, state, and country)
________________________________________________________________________
Home tel. #
PACC membership #
________________________________________________________________________
Grandparent birthplace
___________________________________
CURRENT HIGH SCHOOL/COLLEGE OR VOCATIONAL INFORMATION
School Name
________________________________________________________________________
City
State
________________________________________________________________________
Academic year & major
Expected Graduation Date
________________________________________________________________________
COLLEGE/UNIVERSITY/TRADE OR VOCATIONAL/INFORMATION
Name the college/university or vocational school you plan to attend. If unknown, please list in
your order of preference the schools to which you have applied.
Use official school names. Do not use abbreviations.
School Name
City
State
________________________________________________________________________
School Name
City
State
________________________________________________________________________
School Name
City
State
________________________________________________________________________
COMMUNITY SERVICE AND EXTRACURRICULAR SCHOOL ACTIVITIES
List all school activities in which you have participated in the past four years (e.g. student
government, music, sports, etc.). List all community activities in which you have participated
without pay for the past four years (e.g. Boy/Girl Scouts, hospital volunteer, Senior Center, food
drive, animal shelter, Special Olympics). Be sure to note any special awards and honors
received, and any title or office held.
Activity
Description
No. of yrs. participated
_______________________________________________________________________
Activity
Description
No. of yrs. Participated
RECOGNITIONS
Briefly elaborate on the activity you have found to be the most meaningful to you.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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Special Awards/Honors
_______________________________________________________________________________
_________________________________________________________________
ESSAY (Required)
An essay with no less than 300 words, must be included with this application, detailing proof of
Portuguese Ancestry, and interest in the Portuguese language and culture and plans for
contributing to the Portuguese-American Community after the completion of your studies.
ATTACHMENTS
Along with a printed, signed and dated application, the applicant must submit a number of
documents to ensure that a fair and unbiased evaluation is made. The student is responsible for
submitting all materials on time, to the Portuguese American Cultural Center of Palm Coast, Inc.
“Scholarship Fund Committee”. This application for a scholarship becomes complete and
valid only when P.A.C.C. has received all of the following materials:
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Two recent letters of recommendation addressed to PACC from any of the
following sources: guidance counselor, teacher, principal, coaches, ministers or
community business leader. These letters should address your character,
academic and or community promise and achievements.
YOUR MOST RECENT OFFICIAL HIGH SCHOOL OR COLLEGE TRANSCRIPTS
INCLUDING GRADING SCALE AND ALL AVAILABLE SAT SCORES.
Essay as mentioned above, with attached proof of Portuguese Ancestry (omit if
previously submitted).
A recent photo of applicant, suitable for printing.
Proof of service hours performed at P.A.C.C. of Palm Coast.
ELIGIBILITY REQUIREMENTS FOR AN ACADEMIC MERIT SCHOLARSHIP
1.
2.
3.
4.
5.
6.
7.
P.A.C.C. family member: The applicant must be a member or a legal child of a
paid P.A.C.C. member, in good standing, for at least the past two full consecutive
calendar years.
Proof of Portuguese Ancestry, from a least one parent, grandparent or greatgrandparent. (omit if previously submitted)
Citizenship status: Must be a U.S. Citizen or Permanent Resident.
Applicant must be an accepted full time student, with a 12 credit minimum
per semester to an accredited College or University or currently enrolled; and
the total number of scholarships received from P.A.C.C. cannot exceed (4) four.
Student must carry a minimum 3.0 GPA cumulative at time of application
submittal. For high school students, SAT scores may be taken into consideration
in the case of a tie.
Applicant must perform 10 hours of service to the Portuguese American Cultural
Center of Palm Coast, and be available to work on the day of ceremony, October
15th, 2016. This requirement must be completed before December 31st, of the
current year. Award is contingent on fulfillment of this requirement. Service
hours form shall be signed by the organization director or Scholarship Committee
Chairperson.
Attendance at Scholarship Banquet is required to receive the award and proper
attire is recommended.
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ELIGIBILITY REQUIREMENTS FOR A CULTURAL MERIT SCHOLARSHIP
1.
2.
3.
4.
5.
6.
7.
P.A.C.C. family member: The applicant must be a member or a legal child of a
paid P.A.C.C. member, in good standing, for at least the past two full consecutive
calendar years.
Proof of Portuguese Ancestry, from a least one parent, grandparent or greatgrandparent. (omit if previously submitted)
Citizenship status: Must be a U.S. Citizen or Permanent Resident.
Applicant must be a student, to an accredited Institution or currently enrolled;
and the total number of scholarships received from P.A.C.C. cannot exceed (4)
four.
Student must have a substantial and active involvement in the Portuguese
American Cultural Center of Palm Coast, and be available to work on the day of
ceremony, October 15th, 2016.
Attendance at Scholarship Banquet is required to receive the award and proper
attire is recommended.
Award is contingent on fulfillment of these requirements.
The Portuguese American Cultural Center of Palm Coast, Inc., Scholarships are awarded to
qualifying students who demonstrate an eagerness to succeed in their chosen fields and are
proud of their heritage, and believes it is never too late for Portuguese Americans to connect to
the rich cultural heritage of their parents, grandparents, or great-grandparents.
DEADLINE: Deliver the above attachments with your application, by September 1,
2016 to: Portuguese American Cultural Center of Palm Coast, Inc. 1200 Palm Harbor
Parkway, Palm Coast, FL 32137
Attn: Scholarship Committee
I acknowledge decisions of the Portuguese American Cultural Center of Palm Coast, Inc.
Scholarship Committee are final. I certify that I meet the basic eligibility requirements of the
program as described in this application and that the information provided is complete and
accurate to the best of my knowledge. If requested, I agree to provide proof of information I
have given in this application.
________________________________________________________________________
Applicant Signature
Date
________________________________________________________________________
Parent Signature
Date
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PORTUGUESE AMERICAN CULTURAL CENTER OF PALM COAST, INC.
SCHOLARSHIP FUND
RECORD OF SERVICE HOURS
NAME: ________________________________________
Date
No. of hours
duties
Location
1. ___________________________________________________________________
2. ___________________________________________________________________
3. ___________________________________________________________________
________________________________________________________________________
Signature and title of Organization Director
date
Tel. #____________________________
________________________________________________________________________
Signature and title of Organization Director
date
Tel. #____________________________
________________________________________________________________________
Signature and title of Organization Director
date
Tel. _____________________________
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