BETH ANN BROOKS MEMORIAL SCHOLARSHIP
(FOR MILLARD SOUTH HIGH STUDENTS ONLY)
DUE DATE FOR THIS SCHOLARSHIP IS: February 1st
SPECIAL REQUIREMENTS:
1.
2.
3.
4.
5.
6.
7.
One scholarship estimated to have a value of $325.00 will be awarded.
The scholarship is open to students who demonstrate a strong commitment to English or Journalism. This commitment should be
evident in the applicant’s responses to the questions on the application.
Shall have academic standing in the upper 50% of your class, with at least a 3.0 grade average.
Shall have completed two academic years at Millard South High School (by the end of the Sr. year), and be eligible to graduated
from Millard South High School by June of this year.
Shall have been involved in some type of work experience during high school. Volunteerism of a significant form will be
accepted as work experience.
Shall demonstrate proficiency in writing with an autobiography.
Please use this signed document as the cover sheet for your application. Scholarship applications must be returned to the Millard
Public Schools Foundation, 5225 S. 159th Avenue, Omaha, NE 68135 by the end of the school day on February 1st!
IMPORTANT NOTE TO APPLICANT: Respond to the following topical requests (sections A through F) by setting up the topic
headings and specific information accompanying each one on a separate attachment. You may put more than one topic on a page.
Provide your response to each topic in a neat, well organized manner. Allow one line of space between the topic request and your
response. Sections A through F must be typed or computer printed. Do not repeat the same information in more than one section.
A. Importance of Further Education - Write a paragraph or two on the subject “Why it is important for me to further my
education.” Include your intended major if that information is known at this time. Include a brief description of your short
and long range goals.
B. School Related Experiences - List all school clubs and activities in which you have participated. List all activities
(music, athletics, plays, etc.) in which you participated during your elementary, middle, and senior high school years. Note
that athletics is in Section D below.
C. Interest &Activities - Select the one interest or activity which has most influenced your development and describe how it
has done so.
D. Athletics - List all athletic activities in which you have participated. Indicate the specific years of participation, the title
of any leadership position; and whether you received a varsity letter.
E. Work Experience - List work experience and summer employment that you have held. Also, list any volunteer work that
you have not previously reported. Give specifics on the number of hours worked and duration of the jobs. Include an
explanation of duties and responsibilities if not self-explanatory.
F. An Autobiography should be attached to this application. Include interest, church and community awards and offices
held which have contributed to candidate’s development.
REQUIRED:
We certify by our signatures below that the responses on this application, including those on the attached sheets, are true
and factual and that we have read and understand the application requirements for this scholarship and the criteria for
accepting it.
_________________________________________________
Student Applicant
_____________________________
Date
_________________________________________________
Parent or Guardian
_____________________________
_________________________________________________
Counselor
Date
_____________________________
Date
2016
2017
MILLARD PUBLIC SCHOOLS FOUNDATION GENERAL SCHOLARSHIP
APPLICATION FORM
General Requirements:
1. The scholarship must be used for undergraduate study at an accredited university, college, or other post
secondary educational institution of the recipient's choice. The award winner must begin attendance at the
selected institution by October in the year of high school graduation.
2. Criteria that will be applied to the selection process for this scholarship include, but are not necessarily limited to
the following.
The Student Applicant:
a. Shall have participated in school and community activities during his/her high school career.
b. Must be eligible to graduate from a Millard Public high school by June of this year.
c. Shall have not been awarded, nor will be awarded by August 15th of this year, any ONE scholarship having
a value equal to or greater than one year's total cost (full ride) at the institution in which they enroll. If
such award is accepted AFTER submitting this scholarship application, it becomes the obligation of the
recipient to report this fact to the Millard Public Schools Foundation. The Millard Public Schools
Foundation will then award the scholarship to an eligible runner-up.
d. Must submit this fully completed application in order to be considered for this scholarship.
3. This scholarship is funded through contributions to the Millard Public Schools Foundation. 4. All applications must be typed or computer printed. All parts of this application are to be completed by the applicant only. 5. If the due date falls on a Saturday, Sunday, holiday or other non school day, the application is due by 10:00 A.M. on
the next day that school is in session after the due date.
6. The scholarship award winner and an alternate will be determined no later than March 1st by a selection
committee established by the donor of this scholarship. The names of the winner and the alternate will be
reported to the Millard Public Schools Foundation by March 1st. All applications and supporting information will
become the property of the sponsor, who will have discretionary authority in all matters pertaining to this award.
Award winners will be notified by the Millard Public Schools Foundation during the month of April.
7. Funds will be disbursed during the months of August and September. The scholarship check will be made
payable to the student applicant, upon receiving verification of enrollment. Verification of enrollment must be
provided by the Office of the Registrar of the college or university that the student will be attending. Checks will
be issued through the Millard Public Schools Foundation.
8. The student applicant is directly responsible for delivering or mailing this completed application to the address
indicated in the special requirements section.
2017
Page 2 (Millard Public Schools Foundation General Scholarship Application Form)
Applicant Name:__________________________________________________________________________
Address: ________________________________________________________________________________
City, State, Zip: __________________________________________________________________________
Applicant Preferred Number: _______________________________
Applicant Email:___________________________________________________________________________
Millard Schools Attended:
Elementary: ________________________________
Grades Attended: ___________
Elementary: ________________________________
Grades Attended: ___________
Middle: ____________________________________
Grades Attended: ___________
Middle: ____________________________________
Grades Attended: ___________
High School: ________________________________
Grades Attended: ___________
High School from which you will graduate from: ___________________________________
Institution you are planning to attend this fall. If you are considering more than one, please list in the order of
preference:
1. ______________________________________________________________________________
2. ______________________________________________________________________________
3. ______________________________________________________________________________
Parents/Guardians (Please indicate if parent is deceased)
Father/Guardian’s Name: ___________________________________________________________
Address (If different from students)____________________________________________________
City, State, Zip: ___________________________________________________________________
Preferred Telephone: _________________________
Father/Guardian’s Email: ____________________________________________________________
…………………………………………………………………………………………………………..
Mother/Guardian’s Name: ___________________________________________________________
Address (If different from students)_____________________________________________________
City, State, Zip: ____________________________________________________________________
Preferred Telephone: _________________________
Mother/Guardian’s Email: ____________________________________________________________
G.P.A. ____.______ CLASS RANK _______OUT OF _______ ACT COMPOSITE SCORE: ______ SAT _______
_________________________________________________
Student Applicant Signature
_____________________________
Date
_________________________________________________
Parent or Guardian Signature
_____________________________
Date
_________________________________________________
Counselor’s Signature
_____________________________
Date
2017