MIDWESTERN STATE UNIVERSITY SPANISH MAJOR
ThankyouforyourinterestintheZavalaHispanicCulturalInitiativeScholarshipprogram.Thisapplicationis
opentoanycurrentMSUstudentorhighschoolstudentwhoplanstoattendMidwesternStateUniversityinfall
2017asadeclaredSpanishMajor.Applicationdeadlineforthis$1,000scholarshipis10Feb2017,and
applicationsmustbepostmarkednolaterthanthisdatetobeconsidered.Allinformationwillbekept
confidentialwithinourscholarshipprogram.Pleasesubmitacompletedapplicationtothefollowingaddress:
ZavalaHispanicCulturalInitiative
Attn:ScholarshipCommittee
P.O.Box373
WichitaFalls,TX76307
Acompleteapplicationpacketincludesthefollowing:
Six-pagescholarshipapplication(includingfinancialinformationandessay)
Oneofficialcollegeorhighschooltranscript(pleaseallowatleast2weeksforreceiptfromyourschool)
Twolettersofrecommendation:
1.Anacademicletterofrecommendationfromaninstructor,advisor,administrator,etc.
2.Apersonalletterofrecommendationfromaresponsiblepersoninyourcommunitywho
knowsyouwellandcanattesttoyourpersonalqualitiesandabilities.Afamilymemberor
casualacquaintancemaynotwritethisletter.
Additionaldocumentsmayberequesteduponreviewoftheapplication.
PERSONALINFORMATION:
LastName:__________________________________________FirstName:______________________________________MI:__________
Telephone:_____________________________________AlternativeTelephone:______________________________________________
Address:__________________________________________________________________________________________________________________
City:__________________________________________________
State:_________________
Emailaddress:_____________________________________________
Zip:_________________
DateofBirth:_________________________
#1NameofParent/Guardian:___________________________________________________________________________________________
Address(ifdifferentfromabove):_____________________________________________________________________________________
Occupation:_______________________________________________Employer:_________________________________________________
#2NameofParent/Guardian:__________________________________________________________________________________________
Address(ifdifferentfromabove):_____________________________________________________________________________________
Occupation:_______________________________________________Employer:_________________________________________________
Has(eitherof)yoursupportingparent(s)/guardian(s)earneda4-yearbachelor’sdegree?
(Checkone):☐YES☐NO
Last Name: ________________________ First Name: _____________________________ MI: _____
2017-2018 Academic Year Page 1 of 6 MIDWESTERN STATE UNIVERSITY SPANISH MAJOR
ForHighSchoolApplicant.Asof01January,yourSenioryear
INFORMATION:(YoumustprovideanofficialtranscriptfromHighSchool)
HighSchoolAttended:_____________________________________________________________________________________________
ExpectedGraduationDate:________________________
ClassRank:_____________
CurrentGPAona4.0Scale:___________________
NumberofStudentsEnrolledinClass:__________________
SATScores: Reading:_______Math:_______Writing:_______
ACTScores: Reading:_______Math:_______Writing:_______Science:_______
Total:__________
Total:__________
ForMSUApplicant.AsoftheendofFall2016
INFORMATION:(Youmustprovideanofficialtranscript)
DateAccepted:____________________________________
OrDateApplied:_________________________________________
StudentMNumber:__________________________________________
AcademicMajor:______________________________________________________ Minor:____________________________________
ExpectedGraduationDate:_________________________________
CurrentGPAona4.0scale:______________________
AllApplicantsanswerthefollowingquestions:
1. WhydidyouchooseMidwesternStateUniversity?
2. HowdoyoufeelMidwesternStateUniversitywillprepareyouforsuccess,bothinyourintendedmajor
andingeneral?
3. Howareyoufinancingyourcollegeeducationandhowwillascholarshipimpactyourplan?
OTHERSCHOLARSHIPSRECEIVED/APPLIEDFOR:(Useadditionalsheetofpaperifnecessary)
ScholarshipName
Amount Received(YesorNo)
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
TotalScholarship$PROMISEDorRECEIVEDtodate:_________________________________
Last Name: ________________________ First Name: _____________________________ MI: _____
2017-2018 Academic Year Page 2 of 6
MIDWESTERN STATE UNIVERSITY SPANISH MAJOR
ACTIVITIES:
Listanyextracurricularactivitiesinwhichyouparticipatedwhileincollegeinappropriatesectionsbelow
(includeanyadditionalinformationonseparatepieceofpaperifneeded):
AcademicAwards/Honors:
Organization
Award/Honor
Position/OfficeHeld
Year(s)
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
ExtracurricularActivities(Memberships,Organizations,Sports,etc.):
Organization
Award/Honor
Position/OfficeHeld
Year(s)
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Volunteer/CommunityInvolvement:
Organization
Award/Honor
Position/OfficeHeld
Year(s)
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
EMPLOYMENTINFORMATION:
Employer
DatesofEmployment
No.ofHoursWorkedperWeek
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Last Name: ________________________ First Name: _____________________________ MI: _____
2017-2018 Academic Year Page 3 of 6
MIDWESTERN STATE UNIVERSITY SPANISH MAJOR
FINANCIALINFORMATION:(Informationwillbekeptconfidentialwithinourscholarshipprogram)
☐Iamusingestimatednumbers(wereservetherighttorequestverification)
☐Iamusingactualnumbers
☐IamaDependent(HaveparentscompletetheformusinginformationfromtheircurrentFederal
IncomeTaxreturn.Ifyourparentshavenotfiledtaxesbythetimetheyarefilling
thisout,theymayuseestimatednumbers.)
☐IamIndependent(Informationaboutyouandyourspouse(ifapplicable)mustbeincluded.)
FiguresshouldbetakenfromyourcurrentFederalIncomeTaxreturn.
Youmayclaimindependentifyouare:
Ø 24yearsofageorolder,or
Ø Haveservedinthemilitary,or
Ø Areawardofthecourt,or
Ø Aremarriedandlivingawayfromyourparents,or
Ø Havenotbeenclaimedbyyourparentsfortwoconsecutiveyearsandhave
earnedatleast$4,000ineachofthosetwoyears
ReportingTaxYear:_______________
AdjustedGrossIncome:___________________________________________________
TotalU.S.IncomeTaxPaid:___________________________________________________
Wages,salaries,tips,earnedfromworkbySelf:___________________________________________________
Wages,salaries,andtips,earnedfromworkbySpouse:___________________________________________________
AllUntaxedIncomeandBenefit:___________________________________________________
(Childsupport,AFDC,ADC,SSI,etc.)
Cash,Savings,Stocks,Bonds,CD's,etc.:___________________________________________________
Netvalueofrealestateholdingnotusedasprimaryresidenceandnotbusinessorfarm
(marketvaluelessbalanceofmortgage):___________________________________________________
Netvalueofbusinessorfarm:___________________________________________________
Parent’s/Guardian’scurrentmaritalstatus:__________________Student’scurrentmaritalstatus:___________________
No.ofchildreninfamily:_________ No.ofchildrenattendingcollege2017-2018academicyear:_________
ExtenuatingCircumstances:Ifyouandyourfamilyhaveunusualcircumstances,pleaseusethespace
belowtoexplain,includeanydetailsthatmayberelevant.(Useadditionalsheetofpaperifnecessary)
Last Name: ________________________ First Name: _____________________________ MI: _____
2017-2018 Academic Year Page 4 of 6
MIDWESTERN STATE UNIVERSITY SPANISH MAJOR
ESSAY:
Completeanessayonseparatepieceofbondpaper
Format:
• 8½x11inchwhitepaper
•
Mustbetyped
•
Use12-pointfont
•
Double-spaced
•
1inchmarginsonallsides
•
Fastenpageswithastaple
•
Theessayshouldnotexceed650words
•
Spell-checked/grammar-checked
•
Paperwillhaveyourfullname
Theessayshouldaddressthefollowingtopic:
“HowtoCultivateAppreciationofLanguageLearninginourCommunity”
(Pleaseincludehowyouwouldcarryoutthesetasksandgiveexamples)
Yoursignature,theapplicant,mustbeonthelinebelow:
Mysignatureonthisformsignifiesthattheessaysubmittedalongwiththisapplicationismyownwork.
________________________________________________________________________ SignatureofApplicant
________________________
Date
Last Name: ________________________ First Name: _____________________________ MI: _____
2017-2018 Academic Year Page 5 of 6
MIDWESTERN STATE UNIVERSITY SPANISH MAJOR
CERTIFICATION:
Pleasereviewstatementsbelowandinitialshowingyouunderstandandagreetotheseterms.
________Icertifythatalltheinformation,includingfinancialinformation,onthisformistrueandcompleteto
thebestofmy(our)knowledgeandtheessayismyownwork.IfaskedbyZavala,I(we)agreetogive
documentationforinformationgivenonthisform.I(we)realizethatthisproofmayincludeacopyofa
FederalTaxReturn.I(we)realizethatfailuretocomplywitharequestforfurtherinformationmayprevent
theapplicantfrombeingconsideredforscholarships.Iunderstandthatfalsificationofanykindofany
informationmayresultintheterminationofthescholarshipifoneisgrantedtome.
________Iunderstandthatthisapplicationwillbesubmittedviamail.Itistheapplicant'sresponsibilitytoprint
andsubmitacompleteapplicationandsupportingdocumentsasnotedbelowbymailto:
ZavalaHispanicCulturalInitiative
Attn:ScholarshipCommittee
P.O.Box373
WichitaFalls,TX76307
________Completeapplicationmustbepostmarkedby10Feb2017tobeconsidered.
________Completeapplicationincludes:
Six-pagescholarshipapplication(includingfinancialinformationandessay)
Oneofficialcollegetranscript(pleaseallowatleast2weekstoreceivetranscriptfromyourschool)
Twolettersofrecommendation
1.Anacademicletterofrecommendationfromyourschoolinstructor,advisor,administrator,etc.
2.Apersonalletterofrecommendationfromaresponsiblepersoninyourcommunitywhoknowsyou
wellandcanattesttoyourpersonalqualitiesandabilities.Afamilymemberorcasualacquaintance
maynotwritethisletter.
________ScholarshiprecipientmustbeadeclaredSpanishmajorenrolledatMidwesternStateUniversity,fulltime,duringthe2017–2018academicyear.Theawardedscholarshipmonieswillbeappliedin$500
incrementsduringtheFall2017andSpring2018semesters.
________Itisthescholarshiprecipient’sresponsibilitytoprovidetheirMidwesternStateUniversity
StudentMNumber.
________Scholarshiprecipientisrequiredtosubmitahand-writtenthank-youletteraddressedtothe
scholarshipsponsorandmailittoZavala’sP.O.Box(addressabove)withinfour(4)weeksofbeingnotifiedof
theirselectionforanaward.
_____________________________________________________________
________________________
SignatureofApplicant
Date
_____________________________________________________________
________________________
SignatureofParent/LegalGuardian
Date
[email protected].
Scholarshipwinnerswillbenotifiedviaphonecallandwillreceivetwoticketstothe2017ZavalaLeadership
Banquet(tentativelyscheduled08April2017)wheretheawardwillbepresented.
Last Name: ________________________ First Name: _____________________________ MI: _____
2017-2018 Academic Year Page 6 of 6