SCHOLARSHIP APPLICATION - UT High School

APPLICATION INSTRUCTIONSBecause we will be selecting scholarship recipients based on the information you provide, it is important that you complete this application as fully and as accurately as you can. It is also important that you follow instructions carefully and either type your application or write legibly.

PROGRAM DESCRIPTIONThe scholarship program of the University of Texas High School (UTHS) is designed for students who need the flexibility of online learning but do not have the financial resources to enroll in UTHS online courses.

ELIGIBILITYSeniors who reside in Region 13 and need one to six semester credit(s) to complete graduation requirements are eligible to apply for scholarship enrollments in online courses from the UTHS. Counties in Region 13 include Bastrop, Bell, Blanco, Burnet, Caldwell, Comal, Fayette, Gillespie, Gonzales, Guadalupe, Hays, Kendall, Lee, Llano, Milam, Travis, and Williamson. Scholarships to the the UTHS Diploma Program are also available. Contact our office for more information.

SELECTION CRITERIAThe following criteria will be considered for selecting the scholarship recipients:

• Academic readiness to succeed with senior level online courses• Financial need and personal circumstances resulting in the need for educational flexibility• Motivation to participate in the UTHS

ITEMS THAT MUST BE SUBMITTEDTo apply for a scholarship, please submit the following items:

1. Scholarship Application (You may print a blank application or you may use a computer to type youranswers and then print your application. If you are writing your application by hand, please print legibly.)

• Part 1 –Student and School Information• Part 2 –Essay Questions and Financial Information• Part 3 –Two Student Recommendation Forms (completed by your high school educators)

2. A copy of your most recent high school transcript

SUBMISSION INSTRUCTIONSYou may submit your application by mail, in person, or by email at the following addresses:

Attn: University of Texas at Austin UT High SchoolP.O. Box 7700Austin, Texas 78713-7700

Physical Address:Development Office Building2901 N I-35, Ste. 2.302 or Ste. 2.410Austin, Texas 78722

Email: [email protected]

SCHOLARSHIP APPLICATION

Scholarship Application Student and School Information Form (Part 1)Applicants must reside in Region 13. Complete the fields below and then submit the form using the information listed on the instruction page.

STUDENT INFORMATION

Male Female

UT EID (Skip if unknown.) Birth Date Check One

Name:Last First MI

Address:Street Apt #

City State ZIP

Phone:Primary Secondary

Email:

ABOUT YOURSELF

Please type your application or write legibly. Each answer is limited to a maximum of 150 words or the space provided.

1. In what extracurricular and community activities have you participated? Include sports, band, school clubs, church or community organizations, part- time jobs, and volunteer work. During which school years did you participate? In which activities, if any, did you hold a leadership position?

2. Please list any awards, honors, academic achievements, and recognition that you have received.

3. Please tell us about yourself. What are your interests?

4. Please tell us about your personal history. Tell us about your family (siblings, if any), and where you were born and raised.

5. Provide additional information about yourself that you want to share with the selection committee.

PARENT/LEGAL GUARDIAN INFORMATION Complete this section, if student is under the age of 18.

Name:Last First MI

Email: Phone:

HIGH SCHOOL INFORMATIONList all the high schools you have attended and attach the most recent transcript.

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Scholarship Application Essay Questions-Financial Information Form (Part 2)Complete the fields below and then submit the form using the information listed on the instruction page.

ESSAY QUESTIONSPlease type your application or write legibly. Each answer is limited to a maximum of 150 words or the space provided.

1. Why do you want to attend the UT High School? Describe in detail any circumstances that are affecting your ability to reach your graduation goal.

2. Why are you requesting a scholarship? Describe in detail.

3. Explain your educational and career goals. How will you contribute to society or make a difference in the lives of others?

FINANCIAL INFORMATION

Has the student recently qualified for free and reduced-price meals? Yes No If yes, at what school?___________________________________ If no, complete the Household Annual Income section.

HOUSEHOLD ANNUAL INCOME

List the names of everyone in the household, including the applicant. For each person, enter the annual amount of income earned.

First Name Last NameCheck if no

Income

Earnings from Work before Deductions

Welfare, Child Support, Alimony

Social Security, Pension,

RetirementOther Income

CERTIFICATION

In signing this application, I certify the student and income information provided is complete and accurate to the best of my knowledge.

Student Name (Print) Student Signature (Required for students age 18 or older)

Date

Parent/Legal Guardian Name (Print) Parent/Legal Guardian Signature(Required for students under the age of 18 )

Date

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Scholarship Application Student Recommendation (Form Part 3)This form is only required for students applying for the UTHS Diploma Program. It should be completed by an educator who has personal knowledge of the scholarship applicant.

APPLICANT INFORMATION

Student Name: School:Last First MI

Educator Name: Educator Email:Last First MI

Please provide an assessment of the applicant’s characteristics as part of our criteria for selecting students who will receive a scholarship to attend The University of Texas at Austin UT High School. UTHS Diploma Program scholarships will be awarded to highly-motivated students residing in Region 13 who need from four to six semester credits to graduate from high school.

STUDENT CHARACTERISTICS

Outstanding Very Good Good Fair PoorUnable to

Judge

ACADEMIC READINESSAbility to succeed in courses at the appropriate grade level for his or her age.

MOTIVATIONCommitment to earning a high school education.

INTERPERSONAL RELATIONSAbility to get along with others, rapport, cooperation, attitude toward receiving instruction.

RELIABILITY Dependability, sense of responsibility, promptness, conscientiousness.

LEADERSHIP Ability to initiate, lead, and set an example for others.

COMMUNICATION SKILLSVerbal skills, clarity of expression, articulateness, clarity and conciseness of written expression.PERSEVERANCEContinues trying to accomplish goals even when it is difficult.

INTEGRITYHonesty, trustworthiness.

CREATIVITYAbility to generate new and novel ideas, or approaches to problems.

ADDITIONAL COMMENTS

Please write additional comments about the student or his or her strengths.

OVERALL RECOMMENDATION

This applicant receives my highest recommendation without reservation

I recommend this applicant with confidence

I recommend this applicant

I would not recommend this applicant

Educator Signature Date

CONTACT INFORMATIONAddress:P.O. Box 7700Austin, TX 78713-7700

Phone:(866) 361-UTHS(512) 471-4808

Website:highschool.utexas.edu

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