2011 APPLICATION

Please complete all information requested below.  Information may be typed or legibly hand-written.  Information provided will be used by the Q.A.C.H.S. Alumni Association Scholarship Committee in consideration for awarding this one-time scholarship.

Download a PDF Application Here!

Part A

    1.  Full Name                

    2.  Full Address          

    3. Phone number        

    4. Date of birth          

    5. Father/ Guardian      

            Address (if different) 

    6. Mother/ Guardian    

            Address (if different) 

    7.  Name(s) of institutions (2yr./ 4yr./ Trade or Technical School) to which you

        have applied and have been accepted: 

        (Please Do Not use more than the allotted space as it will not print properly)

    8. The name of the Q.A.C.H.S. Alumni Association member from whom you are a direct

        descendant and his/ her year of graduation:

            Member         Year of graduation

            Address

            Phone number

9.  In a brief statement, describe your plans for higher education and explain how

    you hope to apply this education  to your future career and personal ambition

    goals: ( Please attach a typed essay, 500 words or less, to a completed application form)

10.  Submit official high school/ college transcript with the application.

Part B

Submit a one-page formal resume that includes the following headings:

        ● Contact information

                ◦ Name

                ◦ Address

                ◦ Phone number(s)

                ◦ Email address

        ● Objective (Vocational objective)

        ● Education (Schools attended, years)

        ● Work Experience (as applicable)

                ◦ Dates

                ◦ Place(s) of employment

                ◦ Job responsibilities/ duties

        ● Activities (as applicable)

                ◦ School-related

                ◦ Community/ volunteer

                ◦ Honors/ awards/ special talents

Part C

Submit a 300 - 500 word essay on the following topic:

Which of the following "Character Counts" pillars has most influenced you as a

person:  trustworthiness, respect, responsibility, fairness, caring, citizenship?

* Essay will be evaluated on content and form.

I certify that the information submitted in this application is complete and accurate.

______________________________         ______________________

Signature of applicant                                Date

______________________________         ______________________

Parent Signature                                        Date

* Note:  Q.A.C.H.S. Alumni Association membership applications are available on the

   Membership Page of this website.  The application form and membership fee

   may be attached to scholarship application.