Professional Documents
Culture Documents
Demonstrate financial need (e.g. eligible for free or reduced price lunch, have an
Expected Family Contribution less than $4,800 according to the fafsa4caster/FAFSA, or
submit an explanation of why you believe you have significant financial need in the
event that your family income exceeds this amounts);
Graduate from high school or receive your GED no later than August 2015 or be
enrolled as an undergraduate student at an accredited college or university.
Participate in a personal interview with the Selection Committee if selected as a semifinalist. Selected students will be notified as to the date, time and location by the end of
December.
Selected students are required to participate in a series of workshops to prepare you for
your transition to college.
Note:
We require our students to:
Apply to a variety of colleges public, private, in-state, community and/or technical colleges
Please submit your completed application along with the additional required documents to the Palmer
Scholars office electronically by November 7, 2014.
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APPLICATION INSTRUCTIONS
Type or word process your essays (12pt. font, 1 in. margins, single spaced)
Required Attachments:
Essays (3)
Essay #1: Introduction to your college roommate (please also include your future aspirations).
Please Note:
Application must be filled out in its entirety. Missing information could disqualify you
from consideration.
All information (transcripts, reference letters, essays, etc.) must be included or your
application packet will be considered incomplete.
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2. Gender:
Male
(Middle)
Female
(Last)
3. Race/Ethnicity:
4. Address:
(Street Number)
(City)
(Zip)
5. Date of Birth:
6. Home Phone:
Cell Phone:
7. E-Mail:
9. Cumulative GPA:
10. Intended College Major and Minor: ___________________ and _________________
11. Expected Family Contribution (EFC) as determined by the Fafsa4caster (citizenship is
not required to complete a fafsa4caster):
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Academic:
Senior Year Schedule: List the classes you are currently taking and the classes you plan to take in your
final semester of high school.
1st Semester Senior/Current Year
Critical Reading
Math
Writing
English
Math
Writing
ACT:
Date Taken/To be
Taken
Yes
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No
Date
Submitted
Date Intend
to Submit
Accepted
Denied/
Waitlisted
Public
Public
Public
Private
Private
Private
C.C.
Tech
12th
11th
Role
10th
Activity - Awards
9th
Please describe your academic and non-academic activities, internships and any awards received while a
student in high school. Academic activities include such things as membership in honor society,
MESA, peer tutoring, etc. Non-academic activities include participation in school sports, clubs, music,
jobs and volunteer experience. Indicate leadership activities such as being an officer in a school club
or serving as an ASB officer or representative. Finally, indicate any academic and non-academic
awards you received. If necessary, add an additional page to list additional activities and/or awards.
Hours/
Week
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Weeks/
Year
Many students have extensive family responsibilities. Please describe what responsibilities you
have/have had that would be considered out of the ordinary. If not out of the ordinary, then what role in
the family did you enjoy most? What responsibility(ies) would you like to have had?
Section G: Status:
1. Legal Status:
Yes
U. S. Citizen:
No
Yes
Legal Resident:
No
2. Dependent Status:
a. Are you a parent?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Briefly describe your disability and any accommodation you may have had in high school/thus far in
college:
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(Middle)
(Last)
(Street Number)
(City)
(Day)
(Evening)
(Occupation)
Address:
(Zip)
Phone:
Employment:
(Middle)
(Last)
(Street Number)
(City)
(Day)
(Evening)
(Occupation)
Address:
(Zip)
Phone:
Employment:
(Middle)
(Last)
(Street Number)
(City)
(Day)
(Evening)
(Occupation)
Address:
(Zip)
Phone:
Employment:
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Mother
Father
Guardian 1
Guardian 2
Self
Yes
No
Yes
No
College/University
Campus
Year in School
Home
Own Apt.
Yes
No
Yes
No
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Renewable
Estimated Amount
I, the undersigned, certify that to the best of my knowledge all of the information on this form is correct. I
understand that the information submitted here and in my Palmer Scholars file may be discussed with the Palmer
staff, and with the Financial Aid Office at the college(s)/university(ies) to which I may be applying or attending.
In addition, if I am selected as a Palmer Scholar I agree to allow the Palmer Scholars staff and
college(s)/university(ies) I may be applying to or attending to use relevant information related to my enrollment,
financial aid, academic progress, contact information, and/or graduation information.
I, the undersigned, consent to allow Palmer Scholars to use my photograph(s), name and story and/or voice for
communication purposes, including but not limited to, printed and online publications, the Palmer Scholars
website(s) and Palmer Scholars social media page(s)/site(s). I also hereby release, defend, indemnify and hold
Palmer Scholars harmless from and against any liability arising from or related to said use. In addition, I, the
undersigned, voluntarily consent to Palmer Scholars' release of certain personal information to Palmer Scholars
mentors. I also hereby release, defend, indemnify and hold Palmer Scholars harmless from and against any
liability arising from or related to a use consistent with said release.
Name (printed)
Signature
Date:
Application and all accompanying documents are due electronically
By November 7, 2014
SHOULD YOU HAVE QUESTIONS ABOUT THE APPLICATION PROCESS, CALL THE
PALMER SCHOLARS FOUNDATION OFFICE at 253.572.9008
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Write a letter introducing yourself to your college roommate. Describe yourself to this person so
that he or she has a well-rounded sense of who you are and who you hope to become before the
two of you meet on campus.
2.
Evaluate a significant experience, risk you have taken or ethical dilemma you have faced & its
impact on you.
Or
What was the most difficult time/period of time in your life? How did you persevere? How did
your perspective on life change as a result of this experience?
3.
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