SECTION I: PERSONAL APPLICANT INFORMATIONMI Preferred First Name Date of Birth Age Gender

Cell Phone

Student’s Last Name

Home Phone

Mailing Address

Father’s Name: Last, First

Mother’s Name: Last, First

SECTION II: CURRENT EDUCATIONAL INFORMATION

GPA (4.0)

Please indicate Elementary, Middle, and High School. Elementary Middle

CommunityService Hours

High School Graduation Date

1A. TRANSCRIPT: I am currently a high school senior, and have included my High School Transcript.

1B. SAT/ACT SCORES: Please answer the following questions regarding your SAT/ACT status. I have attached an official copy of my SAT scores. I have taken the ACT. My composite score is

I have NOT taken either SAT or ACT.

SECTION III: HIGHER EDUCATION INFORMATIONAre you currently enrolled in college/tech school? Yes No If Yes, name institution: List by preference, the institutions to which you have applied. If you have been accepted, please indicate any Merit Aid/Scholarships offered to you. (By Preference)List Institutions Applied To Institution Location: City, State Institution Type Acceptance Status Aid Offered

Please indicate your chosen Major: Please indicate your chosen Minor: Career Choice(s) after College?

What were the deciding factors for your college choice? (Location, Size, Major, Athletics, Cost, etc.)

What do you consider your academic strengths?

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CLSA, Concerned Black Women of Calvert County; P.O. Box 927, Prince Frederick, MD 20678 info@clsap.org

Please continue to 2020 CLSA Page 2

CLSA Original Concept and Form Developed and Authored by Sonia K. Wagner/SK Wagner & Associates

Calvert Local Scholarship ApplicationDeadline: March 9, 2020

I am currently enrolled in college, and have included my College Transcript.

City

Email Address

State Zip Code

Employer/Occupation

Employer/Occupation

County Residence

Student's First Name

Ethnicity - Required

Military Dependent/ Affiliation

GPA (%)

High School

Class Ranking /#Graduates

Please continue to 2020 CLSA Page 3 Page 2 of 5

CLSA info@clsap.org Deadline: March 9, 2020

SECTION IV: STUDENT FINANCIAL INFORMATION1. COPY OF SAR (Student Aid Report) from the FAFSA (Free Application for Federal Student Aid).

The SAR is a one to two page report generated from student’s filing of the FAFSA.Retrieve a copy of your SAR from www.fafsa.gov. Use Student’s PIN to retrieve, request the ‘pdf’ version. Include a copy with CLSA.

2. Describe any extraordinary circumstances in your home/family that may affect your finances and/or future ability to pay for your educational plans.

SECTION V: STUDENT RESUMEStudent Resume is no more than two (2), typed, single-sided pages, in 12 point font. Resume will show relevant personal and occupational information. Below is a non-fillable guide to resume building. Include the Student Resume in the CLSA.

SECTION VI: STUDENT'S LETTERS OF RECOMMENDATIONLetters of Recommendation sealed and signed by recommender. Read Guidelines for Completing the 2020 CLSA.

Academic Reference Name

Community Reference Name

Academic Reference Title

Community Reference Title

Reference’s Email

Reference’s Email

Reference’s Phone

Reference’s Phone

SECTION VII: PROVIDER'S ESSAY

Many Scholarship Providers listed on the CLSA require an essay. Please find those Providers’ offerings listed on the 2020 CLSA Instructions and/or Providers’ Information Sheets, and on www.clsap.org.

1. Extra-Curricular Activities Describe the Activity(ies) List Include Dates (start ...end) Describe Leadership Role

2. Community Service/Volunteer Work Describe the Activity(ies) Include Dates (start ...end) Describe Leadership Role

3. List Awards/Honors/Letters Give the Award Name Date of Award Awarded by

SECTION VIII: SCHOLARSHIP DESIGNATION(S)1. Carefully review the 2020 CLSA Instructions and/or Providers’ Information Sheets (which are listed as separate files) to determine your eligibility.2. Consideration for scholarship awards will be given to student applicants by the individual Scholarship Providers based on the application fully meeting eligibility requirements and

adhering to specific instructions.3. Individual Scholarship Providers reserve the right to eliminate student applicants who indicate eligibility to ALL scholarships listed. Please review your qualifications and

scholarship requirements carefully and mark only those for which you are eligible.

Section VIII(a) Scholarships listed below in Section VIII(a) may require Provider’s Essay (SECTION VII) to fulfill the application requirement.

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***Please mark only those scholarships for which you are eligible for scholarship consideration.***

Extra-Curricular Activities Describe the Activity(ies) Include Dates (start ... end) Describe Leadership RoleList Community Service/Volunteer Work Describe the Activity(ies) Include Dates (start ... end) Describe Leadership RoleList Awards/Honors/Letters Give the Award Name Date of Award Awarded by:Employment Employer Name Dates (start ... end) Job Title/Responsibilities

CLSA info@clsap.org Deadline: March 9, 2020

Alpha Beta Chapter, Delta Kappa Gamma /Frances Lancaster Grant for Teacher Education

American Legion Auxiliary Unit 206 / Clara Mae Buckmaster Memorial

American Legion Auxiliary Unit 206 /Patsy Keyser Memorial Nursing Scholarship/Stallings Williams American Legion Auxiliary Past Presidents Parley

American Legion Post 206/ Austin H Stanley (military descendant requirement)

American Legion Post 206 / Russ Mogel (military descendant requirement)

Calvert Association of Supervisors and Administrators

Calvert Collaborative for Children and Youth Marie Andrews

Calvert County Bar Association Scholarship Program

Calvert Education Association

Calvert High School Athletic Booster Club

Calvert Nature Society

Calvert Retired School Personnel Association

Concerned Black Men of Calvert County

Concerned Black Women of Calvert County

Harriet Elizabeth Brown Scholars Program Scholarship (STEM Leaders for the 21st Century STEM Generation) … for rising 7th, 8th, and 9th grade students only

Huntingtown High School PTSO

Jerry Earnest Parker, Jr. Memorial

Kimberly Ann Stone Memorial

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Kimberly Mackall Empowerment

LEAP Forward / Blanche Newton Finch

LEAP Forward / Clifton Morsell-Randolph Adams Memorial

LEAP Forward / Clyde Jr and Carrie Bertha Jones Memorial

LEAP Forward / The Earl S. Thorne Memorial

LEAP Forward / Evelyn V. Irvine Memorial Scholarship for Community Service

LEAP Forward / George H. & Geneva Green Harrod Memorial

LEAP Forward / Gloria Mae Gross Memorial

LEAP Forward / Grace Parker

LEAP Forward Hamilton Sr and Alice Parran Memorial

LEAP Forward / Lawrence Roy Myers Memorial

LEAP Forward / MacArthur Jones Memorial

LEAP Forward / Nannie Pearl Cade

LEAP Forward / Pamela Renee Offer

LEAP Forward / Raymond Harris Memorial

LEAP Forward / Victoria Lodge #71 F&AM, P.H.A. Memorial

LEAP Forward, Inc. / Violet Parker Memorial

LEAP Forward, Inc. / Wallace Lorenzo Leeper Memorial

LEAP Forward, Inc. / Wilson E. Ennis, Sr. Scholarship

Mark & Ariane Odom

Northern High School PTSO

SECTION IX: CALVERT LOCAL SCHOLARSHIP APPLICANT CHECKLIST

***Mail-In CLSA Requirements / Checklist***

Section VIII(a) (continued) – Scholarships listed below in Section VIII(a) may require Provider’s Essay to fulfill the application requirement.

***Please mark only those scholarships for which you are eligible and include all required documents for scholarship consideration.***

Please continue to 2020 CLSA Page 5 Page 4 of 5

SECTION VIII: SCHOLARSHIP DESIGNATION(S) (CONTINUED)

CLSA info@clsap.org Deadline: March 9, 2020

Omega Pi Omega Chapter of Alpha Kappa Alpha Sorority, Inc.

PrimeTime Children’s & Youth Activity Center

Republican Women Leaders of Calvert / Joyce Lyons Tehres

Republican Women of Calvert County Katherine Carr

Rotary Club of Prince Frederick / The Brian Albright

Rotary Club of Prince Frederick / Eugene Karol

Saint Leonard Heritage

Scholarships by the Democratic Party and Clubs of Calvert

Tau Lambda Lambda Chapter of Omega Psi Phi Fraternity, Inc. and the John Lancaster & W. Cecil Short Charity Foundation

Tri-County (MD) Alumnae Chapter of Delta Sigma Theta Sorority, Inc. /Book Scholarship

Tri-County (MD) Alumnae Chapter of Delta Sigma Theta Sorority, Inc. / Career/Vocational/Technical

Tri-County (MD) Alumnae Chapter of Delta Sigma Theta Sorority, Inc. /Tri-County (MD) Scholarship

Tri-County (MD) Alumnae Chapter of Delta Sigma Theta Sorority, Inc. /Dr. Elvear B. Johnson, PhD.

William Sampson Brooks High School Alumni Association, Inc.

1. CLSA Form. Save file, Print 2 copies - one signed for mail-in, and one signed to file. Mail original, signed application along with other pertinent information by deadline of March 9, 2020.

2. College Transcript. Please attach one (1) college transcript if you are currently enrolled in College, or if you are a Dual Enrolled high school student.

3. Transcript. Seniors attach one (1) official (sealed) high school Transcript. High school Guidance Department will also accept the sealed transcript.

4. SAT / ACT Scores. Please attach a copy of your official SAT and/or ACT test score report. Your copy may be downloaded from the SAT/ACT website.

5. Copy of SAR. FAFSA Student Aid Report (SAR) - received after filing the FAFSA (Free Application for Federal Student Aid) (www.fafsa.gov) Print and attach the PDF version showing the EFC (Expected Family Contribution).

6. Student Resume. Please attach a one (1) or two (2) page single-sided page(s) student resume.

7. Student Essay. Please attach your CLSA essays as requested in Section VII of the CLSA.

8. Additional Documents. Pay special attention to Local Providers requesting additional information for their eligibility requirements.

9. Letters of Recommendation. Mailed-in Letters of Recommendation should be sealed and signed across seal by Recommender.

10. Mail all required documents in one envelope. Counselors and others sending sealed document may mail directly to CLSA Manager.

***Email-In CLSA Requirements / Checklist***SECTION IX: CALVERT LOCAL SCHOLARSHIP APPLICANT CHECKLIST (CONTINUED)

SPECIFIC INSTRUCTIONS1. Calvert Local Scholarship Application: Email the CLSA form, along with all required documents to the email address provided to complete your

scholarship application. Students are advised to send only one application email.2. High School Transcripts:

a. Email a copy of your high school transcripts, along with the CLSA and all other required documents to complete your scholarship application. High school transcript must be signed by a guidance counselor or high school official representing the school. Add the high school transcripts as an attachment in the email.

b. All CLSA applicants are to leave a sealed copy of their high school transcripts in the high school’s drop-off box, unless you are mailing-in the CLSA Packets to the CLSA Manager.

3. College Transcripts: Email a copy of your college transcript, along with the CLSA form and all other required documents to complete your scholarship application in one email. All emailed student applications will be retrieved on the deadline date and no additional emails will be considered after that date. Sealed originals/envelopes can be scanned and emailed with CLSA Packet.

4. SAT / ACT Scores: Email your SAT / ACT Scores, along with the CLSA form and all other required documents to complete your scholarship application in one email. Your scores may be downloaded from the SAT/ACT website.

5. Copy of Student Aid Report: Email your copy of SAR, along with the CLSA form and all other required documents to complete your scholarship application in one email.

6. Student Resume: Email your Student Resume, along with the CLSA form and all other required documents to complete your scholarship application in one email.

7. Student Essay: Email your Student Essay, along with the CLSA form and all other required documents to complete your scholarship application in one email.

8. Additional Documents as Required by Scholarship Providers: Email all required additional documents, along with the CLSA form and all other required documents to complete your scholarship application in one email.

9. Letters of Recommendation: Email all Letters of Recommendation to the CBW email account: info@clsap.org, along with the Calvert Local Scholarship Application and all other required documents to complete your scholarship application in one email.

10. Sealed documents, along with the original envelopes should be scanned and submitted in the CLSA Email Packet.

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1. I give permission to the CLSA Manager to forward my application materials to the Scholarship Providers for whom I have indicated eligibility. 2. I give permission to the CLSA Manager to forward my application materials to Providers who may request to join the CLSA after publication date. You will be notified via

email if your CLSA is forwarded to a new Scholarship Provider joining the CLSA after publication date.

3. I certify that the information provided in the CLSA form is true and complete to the best of my knowledge. I have read the instructions thoroughly and I am providing all information, documents, attachments and essays as required for the individual scholarships to which I am applying. I understand that the CLSA Manager will make copies (electronically or print) of my CLSA Mail-In Packet as submitted and distribute copies to the Scholarship Providers which I have indicated. I am aware that the CLSA Manager is not able to notify me of missing information, and therefore I take full responsibility for the completeness of this application. I understand that only required documents will be copied/scanned and distributed.

SECTION X: signatures and disclaimers

Student’s Signature: Sign, then print below Parent’s Signature: Sign, then print belowDate Date

P.O. Box 927, Prince Frederick, MD 20678 info@clsap.org

CLSA info@clsap.org Deadline: March 9, 2020

Republican Women of Calvert County Katherine Carr Scholarship

1. Students who chose to email their applications are advised to send only one email application to the CLSA application acceptance site(info@clsap.org). No follow-up emails will be accepted.

2. The CLSA Email acceptance site is not staffed. Student applications will be retrieved from email site on the day after the CLSA deadline.

3. Students should closely adhere to CLSA instructions to ensure a timely and accurate submission to fully represent their accomplishments.

4. Applications received after the stated deadline will not be accepted. The deadline is March 9, 2020 by 5:00 pm.

5. Submission of Incomplete / Partial applications will not accurately reflect students’ achievements and may ultimately lead to not being considered for awards by community providers.