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2024 Scholarship Recipients
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my KYCF ACCOUNT
Scholarship Application
About the Applicant
Applicant's Full Name
(Required)
Applicant's Full Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Preferred Contact Number
(Required)
Preferred Email
(Required)
Name of High School
(Required)
Select one
Bethesda-Chevy Chase High School
Montgomery Blair High School
James Hubert Blake High School
Winston Churchill High School
Clarksburg High School
Damascus High School
Thomas Edison High School of Technology
Albert Einstein High School
Gaithersburg High School
Walter Johnson High School
John F. Kennedy High School
Col. Zadok A. Magruder High School
Richard Montgomery High School
Northwest High School
Northwood High School
Paint Branch High School
Poolesville High School
Quince Orchard High School
Rockville High School
Seneca Valley High School
Sherwood High School
Springbrook High School
Watkins Mill High School
Wheaton High School
Walt Whitman High School
Thomas S. Wootton High School
Other
Other: Name of High School
(Required)
Current Cumulative Grade Point Average (GPA)
(Required)
Upload a high resolution photo. (Senior pictures are preferred.)
(Required)
Drop files here or
Select files
Max. file size: 256 MB.
Hidden
Photo Review
(Required)
Select One
Accepted
Not Accepted
About Your Parent
Parent / Guardian Email
(Required)
Parent / Guardian Name
(Required)
Parent / Guardian Phone
(Required)
Do you want to add another parent / guardian?
(Required)
Yes
No
Parent / Guardian Name
(Required)
Parent / Guardian Email
(Required)
Abut Your Extra-curricular Activities
List any high school activities in which you participated.
Name of activity / Club
Office Held
What year did you participate in this activity / club? (Check all that applies)
Freshman
Sophomore
Junior
Senior
Name of activity / Club
Office Held
What year did you participate in this activity / club? (Check all that applies)
Freshman
Sophomore
Junior
Senior
Name of activity / Club
Office Held
What year did you participate in this activity / club? (Check all that applies)
Freshman
Sophomore
Junior
Senior
List awards, scholarships, publications or special recognition you have received.
List your work experiences including part-time, full-time and volunteer positions.
List the areas in which you earned your community service hours.
Post Secondary Education
List the names of the colleges and universities you applied to and provide the status of each application.
College / University
(Required)
City & State
(Required)
Admission Status
(Required)
Waiting
Accepted
Denied
Upload acceptance letter
(Required)
Max. file size: 256 MB.
I want to report another college / university
College / University
(Required)
City & State
(Required)
Admission Status
(Required)
Waiting
Accepted
Denied
Upload acceptance letter
(Required)
Max. file size: 256 MB.
I want to report another college / university
College / University
(Required)
City & State
(Required)
Admission Status
(Required)
Waiting
Accepted
Denied
Upload acceptance letter
(Required)
Max. file size: 256 MB.
Have you decided on what college or university you will be attending in the Fall?
(Required)
Yes
No
Please provide the name of the college / university you will be attending in the Fall.
(Required)
Do you know what you plan to major in as an undergraduate?
(Required)
Yes
No
Please list your planned major here.
(Required)
What additional personal information do you wish to share with the Kappa Youth & Community Foundation’s Scholarship Committee?
Hidden
Judge 1
(Required)
Please enter a number from
0
to
32
.
Hidden
Judge 2
(Required)
Please enter a number from
0
to
32
.
Hidden
Judge 3
(Required)
Please enter a number from
0
to
32
.
Hidden
Judge 4
(Required)
Please enter a number from
0
to
32
.
Hidden
Judge 5
(Required)
Please enter a number from
0
to
32
.
Hidden
Judge 6
(Required)
Please enter a number from
0
to
32
.
Essay
Describe a societal/community problem that you will work to resolve during and/or after your college career.
Use the space below to respond to the essay question.
(Required)
Hidden
Judge 1
(Required)
Please enter a number from
0
to
30
.
Hidden
Judge 2
(Required)
Please enter a number from
0
to
30
.
Hidden
Judge 3
(Required)
Please enter a number from
0
to
30
.
Hidden
Judge 4
(Required)
Please enter a number from
0
to
30
.
Hidden
Judge 5
(Required)
Please enter a number from
0
to
30
.
Hidden
Judge 6
(Required)
Please enter a number from
0
to
30
.
Transcript
Your official transcript must be sent to us by your counselor or school designee. Therefore, we need permission from your parent(s.)
Parent Transcript Consent
(Required)
I am the parent/legal guardian of the above student and have read and consent to the following statement.
This one-time consent gives permission for the School Counseling Office to submit the academic transcript to Kappa Youth & Community Foundation for the sole purpose of determining eligibility for this scholarship application.
Parent/ Legal Guardian Full Name
(Required)
Parent/Legal Guardian's Signature
(Required)
As the applicant, it is your responsibility to ensure that you provide us with the correct email address of your registrar or counselor responsible for sending us your transcript. Your application will not be forwarded to the committee until your registrar or counselor has sent us your official transcript.
Registrar / Counselor's Name
(Required)
Registrar / Counselor's Email
(Required)
Registrar / Counselor's Phone Number
(Required)
Dear Registrar / Counselor, please provide the committee with the actual overall cumulative weighted grade point average for this applicant. In addition to the applicant's GPA, please also enter the grading scale used to calculate this average.
Hidden
Cumulative Weighted Grade Point Average
(Required)
Hidden
Grading Scale
(Required)
Hidden
Please upload a copy of this student's official transcript using the tool below.
(Required)
Max. file size: 256 MB.
Hidden
Registrar / Counselor's Signature
(Required)
Please use your mouse to provide your electronic signature
Hidden
Judge 1
(Required)
Please enter a number from
0
to
30
.
2.5 – 2.99 =
Worth 10 pts
3.0 – 3.49 =
Worth 20pts
3.5 – 3.99 =
Worth 25 pts
4.0 > =
Worth 30 pts
Hidden
Judge 2
(Required)
Please enter a number from
0
to
30
.
2.5 – 2.99 =
Worth 10 pts
3.0 – 3.49 =
Worth 20pts
3.5 – 3.99 =
Worth 25 pts
4.0 > =
Worth 30 pts
Hidden
Judge 3
(Required)
Please enter a number from
0
to
30
.
2.5 – 2.99 =
Worth 10 pts
3.0 – 3.49 =
Worth 20pts
3.5 – 3.99 =
Worth 25 pts
4.0 > =
Worth 30 pts
Hidden
Judge 4
(Required)
Please enter a number from
0
to
30
.
2.5 – 2.99 =
Worth 10 pts
3.0 – 3.49 =
Worth 20pts
3.5 – 3.99 =
Worth 25 pts
4.0 > =
Worth 30 pts
Hidden
Judge 5
(Required)
Please enter a number from
0
to
30
.
2.5 – 2.99 =
Worth 10 pts
3.0 – 3.49 =
Worth 20pts
3.5 – 3.99 =
Worth 25 pts
4.0 > =
Worth 30 pts
Hidden
Judge 6
(Required)
Please enter a number from
0
to
30
.
2.5 – 2.99 =
Worth 10 pts
3.0 – 3.49 =
Worth 20pts
3.5 – 3.99 =
Worth 25 pts
4.0 > =
Worth 30 pts
Recommendation
Two letters of recommendation are required to have your application reviewed by the committee -- One (1) from the school representative and one (1) from a non-school representative. The persons writing recommendations should specify their relationship to the applicant or the capacity in which they know or have observed the applicant, i.e. teacher, pastor, principal, community leaders, mentor, etc.
School Representative's Name
(Required)
School Representative's Email
(Required)
Hidden
Your relationship to applicant.
(Required)
Select one
Parent
Guardian
Neighbor
Friend
Clergy
Teacher
Grandparent
Other
Hidden
Other: Relationship to applicant
(Required)
Please respond to the following:
(1) How long and in what capacity have you known the applicant?
(2) Please address the following qualities as related to the applicant:
a. Achievement (academic and personal)
b. Leadership (formal and informal)
c. What additional information about the applicant will be helpful to the Scholarship Committee as they make their decision (special circumstances, life events, etc.)
Hidden
Use this space to copy / paste your recommendation for this student.
(Required)
School Representative
Hidden
Judge 1
(Required)
Please enter a number from
0
to
5
.
Hidden
Judge 2
(Required)
Please enter a number from
0
to
5
.
Hidden
Judge 3
(Required)
Please enter a number from
0
to
5
.
Hidden
Judge 4
(Required)
Please enter a number from
0
to
5
.
Hidden
Judge 5
(Required)
Please enter a number from
0
to
5
.
Hidden
Judge 6
(Required)
Please enter a number from
0
to
5
.
Non-school Representative's Name
(Required)
List the name of the non school representative you want to complete your recommendation.
Non-school Representative's Email
(Required)
Hidden
Your relationship to applicant.
(Required)
Select one
Parent
Guardian
Neighbor
Friend
Clergy
Teacher
Grandparent
Other
Hidden
Other: Your relationship to applicant
(Required)
Please respond to the following:
(1) How long and in what capacity have you known the applicant?
(2) Please address the following qualities as related to the applicant:
a. Achievement (academic and personal)
b. Leadership (formal and informal)
c. What additional information about the applicant will be helpful to the Scholarship Committee as they make their decision (special circumstances, life events, etc.)
Hidden
Use this space to copy / paste your recommendation for this student.
(Required)
Non-school Representative
Hidden
Judge 1
(Required)
Please enter a number from
0
to
5
.
Hidden
Judge 2
(Required)
Please enter a number from
0
to
5
.
Hidden
Judge 3
(Required)
Please enter a number from
0
to
5
.
Hidden
Judge 4
(Required)
Please enter a number from
0
to
5
.
Hidden
Judge 5
(Required)
Please enter a number from
0
to
5
.
Hidden
Judge 6
(Required)
Please enter a number from
0
to
5
.
Acknowledgement
Acknowledged each statement below with a check.
I give permission to officials of my institution to release transcripts of my academic record and other information requested for consideration in the Kappa Youth & Community Foundation of Gaithersburg-Rockville scholarship program.
(Required)
I acknowledge
I understand that the contents of the application will be confidential and reviewed only by the scholarship selection committee.
(Required)
I acknowledge
I affirm that I personally completed this entire application.
(Required)
I acknowledge
I affirm the information contained herein is true and accurate to the best of my knowledge and belief.
(Required)
I acknowledge
If awarded a scholarship, I understand that the Kappa Youth & Community Foundation and Gaithersburg-Rockville Alumni Chapter will frequently check in with me during my post-secondary matriculation for progress report and mentoring opportunities.
(Required)
I acknowledge
Applicant's Signature
(Required)
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