DATE 1 February 2012 Senior Guidance Counselor SUBJ: THE DUVAL HOUSE NEW BEGINNING SCHOLARSHIP RANGING FROM

$$250 TO $1,000 OPEN: February 1, 2012 April 20, 2012

SENIOR GUIDANCE COUNSELORS, PLEASE POST FOR ALL SENIORS PLANNING TO ATTEND A 2 YEAR COLLEGE OR A FOUR YEAR UNIVERSITY. FURTHER, INFORMATION REGARDING 18 MAY 2012 AWARDS BANQUET, WILL BE GIVEN TO THE WINNERS.
FOR ADDITIONAL INFORMATION REGARDING THE SCHOLARSHIP CALL 696-5565 home or 904-382-5627 cell, Retired (LCDR) Washington, Herlena Scholarship Chairperson. THERE WILL BE A BANQUET FOR SELECTED RECIPIENTS, AND FAMILY MEMBERS ARE ENCOURAGED TO ATTEND.

THE DUVAL HOUSE NEW BEGINNING SCHOLARSHIP APPLICATION The application must be completely filled out. Use additional sheets of unlined paper as needed. You are responsible for ensuring that your transcripts and SAT or ACT scores are forwarded to the following address 13565 Ashford Wood Ct E. Jacksonville, FL 32218. The address is also listed on the final page of this application. Please complete all seven parts of this application. Incomplete or illegible applications will not be considered. Place your name in the top right comer of each page of your submitted application. (Please Type or Print all information) 1. BACKGROUND Name (Last, first, middle initial) ___________________________________________________ Address: ______________________________________________________________________ City: ______________________________ Telephone: ___________________________ Social Security Number: xxx -xx- ___________ Date of Birth: _______________ Sex:________ State: _______________ Zip: _______________

High School: ____________________________________________________ Counselor: ________________________________ Telephone: __________________________ Your Grade Point Average: ____________________ (4.0 Scale)

SAT Scores: Verbal ______________ Math ______________ 2. GOAL SETTING AND ACHIEVEMENT

or

ACT Scores: English ___________ Math _____________

a. What field of study do you plan to pursue in college? ________________________________________________________________

b.

List at least 2, two year colleges or four year universities to which you have applied or are planning to apply: ___________________________________ _______________________________

THE DUVAL HOUSE NEW BEGINNING SCHOLARSHIP APPLICATION

3.

EXPRESSIVENESS: Write a one (1) page paper describing yourself and your goals. Include in the paper suggestions you would give to the presidential campaign for 2012 for health care, social security, unemployment, and how to stimulate the economy to increase jobs for the American people. Attach please.

4.

EXTRACURRICULAR AND COMMUNITY ACTIVITIES: a. NEATNESS COUNTS. Please type or print all information on a separate sheet of paper with the heading: "EXTRACURRICULAR AND COMMUNITY ACTIVITIES". b. Desired Format: (see below) POSITION HELD Member Secretary President Member Member DURATION (Mo/Yr-Mo/Yr) 10/99-7/01 8/00-7/01 9/99-8/00 10/98-5/00 8/00-7/01 DESCRIBE YOUR ACTIVITY Academic Honors Club Academic Honors Club Academic Honors Club Singer Clinic Assistant

ORGANIZATION EXAMPLE: I. Beta Club 2. Beta Club 3. Beta Club 4. School Ensemble 5. Border Babies etc: 5. WORK EXPERIENCE

a. NEATNESS COUNTS. Please type or print all information on a separate sheet of paper with the heading: "WORK EXPERIENCE b. List all jobs for each school year, even if you worked the same job in a previous school year. For the purpose of this application, the school year runs from 01 August until 31 July of the next year. c. Desired Format: (see below): COMPANY EXAMPLE: 1. Peoples Drug Store 10/99-01/00 Stock Person DURATION (Mo/Yr-Mo/Yr) YOUR JOB DESCRIPTION

2. McDonalds Restaurant etc:

02/00-12/00

Cashier

THE DUVAL HOUSE NEW BEGINNING SCHOLARSHIP APPLICATION 6. AWARDS AND ACHIEVEMENTS: a. NEATNESS COUNTS: Please type or print all information on a separate sheet of paper with the heading: AWARDS AND ACHIEVEMENTS b. List all recognition received for each school year, even if you received the same recognition in a previous school. For the purpose of this application, the school year runs from 01 August until 31 July of the next year. c. Desired Format: (see below) DATE RECEIVED 6/00 6/00 6/01

DESCRIPTION OF RECOGNTION EXAMPLE 1. Sportsmanship Award for Track and Field 2. Outstanding Student Award 3. Outstanding Student Award etc: 7. INCLUDE WITH YOUR APPLICATION: -

One copy of your high school transcript through the Senior year fall semester. Copy of SAT or ACT scores. At least three letters of recommendation (one must be from a counselor OR teacher at YOUR school.) Any college letters of acceptance you may have received (not required, but encouraged.)

All information provided must be true and accurate to the best of the applicants knowledge. Sign here to confirm this statement: _________________________ Date: _________________________ A BRIEF INTERVIEW may follow if you are selected. An awards Banquet will be held 18 May 2012 for recipients. ALL applicants will be notified by phone. Return this application and required documents NOT LATER THAN 20 April 2012 to: Retired LCDR Herlena O. Washington ATTN: Scholarship Committee Chairman 13565 Ashford Wood Ct E. Jacksonville, FL 32218