Scholarship Application Thank You For Taking Time To Apply

scholarship application thank you for taking time to apply for a you can foundation scholarship! to ensure we have all the inform

Scholarship Application
Thank you for taking time to apply for a You Can Foundation
Scholarship! To ensure we have all the information needed and in the
order needed for evaluation, please complete this application in full
and follow the instructions along the way.
Once completed, please submit all your information to the You Can
Foundation as follows:
By Mail: You Can Foundation
ATTN: Scholarship Committee
1501 NW 197th Circle
Edmond, Oklahoma 73012
By Email: [email protected]

1. Applicant’s Full Name:
________________________________________________
LAST NAME FIRST NAME MIDDLE INITIAL
2. Applicant’s Complete Address:
_____________________________________________________
STREET ADDRESS
_____________________________________________________
STREET ADDRESS (SECOND LINE)
_____________________________________________________
CITY STATE/PROVINCE POSTAL CODE/ZIP CODE
_____________________________________________________
COUNTRY
_____________________________________________________
PHONE E-MAIL ADDRESS
3. Date to graduate (or graduated) from high school:
_____________________________
4. Date to enter (or entered) college: _____________________________
5. Name of college(s) (currently attending or applying to) and “proof”
of or means to verify the accreditation of the college:
__________________________________________________________________________
6. Number of years of college completed (if any):
_____________________
7. Statement/Proof of tuition or room and board purchased and used for
last two years, if applying for scholarship after enrollment since
2014 or later: (Include copies of invoices or orders.)
Package
Date Purchased
Date Used
_______________________________________________________________
______________________________________________________________________________________________________________________________
_____________________
__________________________________________
____________________________________________________________________________________
__________________________________________
_______________________________________________________________
8. Indicate which scholarship category you are applying for:
 Dan Dale Said I Can Scholarship
 Bob Ambrosius Scholarship
9. Provide any test scores, such as your official SAT, ACT, or other
academic measures. (Please send us a copy of your official scores as
soon as you have them.)
Test and Score Date
_______________________ _____________________
_______________________ _____________________
_______________________ _____________________
10. List your extracurricular activities (include any descriptions or
details as attachments):
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
11. List the names of your references, limited to three (3) total.
Include reference letter(s) as attachments from no less than two
references. Maximum of 2 pages each, single-spaced, 12-point type; may
be less, such as double-spaced, etc.:
______________________________________________________________
______________________________________________________________
______________________________________________________________
12. What is the title of your personal essay? (Include actual essay as
an attachment, at most 2 pages, single-spaced, 12-point type; may be
less, such as double-spaced, etc.)
______________________________________________________________
13. Any general comments you wish to include? (You may also include
them as an attachment, limited to one page.)
______________________________________________________________
______________________________________________________________
______________________________________________________________
15. I have submitted a photograph to be used if I am selected as a
scholarship winner:
Yes / No [Please note: We welcome digital photos titled with first and
last name to be e-mailed to the address noted above]
16. I have signed and submitted the attached "Assignment of Rights &
Consent to Publish Scholarship Information":
Yes / No
ASSIGNMENT OF RIGHTS & CONSENT TO PUBLISH SCHOLARSHIP INFORMATION
I, ______________________________________________________, do hereby
give The You Can Foundation full rights to publish my name, where I
live (city, state, and country only; actual street addresses and phone
numbers will not be disclosed), my pertinent family information,
college I am attending, photographs that I have provided, and college
update information.
I understand that by execution of this agreement, I am relinquishing
my rights to any future compensation for reproduction, publication or
use of the above information by The You Can Foundation in its print or
electronic correspondence, catalog, or on its website.
I hereby specifically waive my right to review or approve the
modification of the above Information. (Modifications may be made to
accommodate size or content restrictions. Modifications will not be
made to “distort” or “falsify” any information provided.)
I understand that this Agreement in no way obligates The You Can
Foundation to publish or use the above-described information.
EXECUTED this date of ____________________________.
By: ________________________________________
(Print Name)
________________________________________
(Signature)
Witness: ____________________ ______________ _____
(Print Name)
________________________________________
(Signature)
Office Use Only: Review Committee Received _______________ Board
Member__________________________
YCFSAF © 2014
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