FIRST NAME |
|
M.I. |
|
LAST NAME |
|
ADDRESS |
|
CITY |
|
STATE |
|
ZIP CODE |
|
PHONE |
|
EMAIL: |
|
DATE OF BIRTH |
|
Name of parent(s)/guardian(s): |
|
How/where did you hear about this scholarship? |
|
| |
ACADEMIC INFORMATION |
| List the name of the school you attended or from which you are graduating. Please indicate if you were home-schooled. |
HIGH SCHOOL / CITY / STATE |
|
| List the college/university in which you are currently enrolled or in which you plan to enroll as a full-time student for Fall 2012. |
COLLEGE/UNIVERSITY CITY STATE |
|
Intended major/program of study: |
|
| |
SPORT/ATHLETIC INFORMATION |
|
| List in reverse chronological order, beginning with the most recent, all interscholastic athletics and/or competitive sports in which you have participated during high school and/or college. Include dates/years of involvement for each. |
|
| |
| LETTERS OF SUPPORT |
|
| List the name and contact information for the two individuals who have provided letters of support for you. The Scholarship Selection Committee reserves the right to contact these individuals directly. |
| NAME TITLE PHONE NUMBER |
|
| NAME TITLE PHONE NUMBER |
|
| |
| PERSONAL ESSAY |
|
Include an essay with this application outlining your qualifications for this award. The essay must be well-written, typed, and be one to three pages in length. The essay should describe how being lesbian, gay, bisexual or transgender (LGBT) has affected your life, how your sexual orientation or gender identity has impacted participation/involvement in a sport, and the ways in which this involvement has enhanced the perception of the LGBT community (e.g., reduced homophobia and increased awareness and tolerance of LGBT people). The essay should also address your future goals and aspirations.
|
SUPPORTING DOCUMENTS CHECK-LIST
Remember to email/mail the following documents along this application submission (in the subject line please write Team DC Scholarship next to your name):
Official/sealed copy of high school or college/university transcript
Copy of college/university acceptance letter (current high school seniors only)
Two (2) letters of support
Personal essay
Copy of Student Aid Report (optional)
AGREEMENT
By clicking the "Agree" box below, I certify that the information on this application and all attachments are true and correct. I understand that the Team DC Student-Athlete Scholarship Selection Committee may conduct investigations related to the information I have provided herein and agree to hold the Committee harmless of any claims of liability resulting from these investigations.I understand that any false or misleading information may disqualify me from consideration for a Team DC Student-Athlete Scholarship.
I understand and acknowledge that the intent of this scholarship is to provide financial support to self-identified gay, lesbian, bisexual or transgender student-athletes.
I understand that, if awarded a scholarship, I will be required to submit proof of registration as a full-time, degree seeking student at a two- or four-year college or university in the United States for the Fall 2011 semester before any award payment will be made. Furthermore, I understand and accept that failure to be properly registered can lead to revocation of the full amount of the award.
|
I agree to the above |
|
Write your full name here to certify agreement: |
|
Agreement Date: |
|
If awarded a scholarship, and if mutually concurred, I agree to allow Team DC to use my name and picture in any newsletter, Web site, press release or other lawful media in recognition as a recipient of the scholarship.
SIGNATURE OF APPLICANT DATE
Submit complete application and all required documents online to scholarship@teamdc.org or mail to:
Team DC
Attn: Student-Athlete Scholarship Award Committee
2910 Sycamore Street, Alexandria, VA 22305
Application must be postmarked no later than June 15, 2012. Incomplete applications or applications postmarked after the deadline will not be considered. |
| |
|
