PIEDMONT SILVER EAGLES CHARITABLE FUNDS, INC.
EDUCATIONAL SCHOLARSHIP FUND
CANIDATE APPLICATION

PARTS I-V should be completed by the candidate
Parts VI should be completed by the recommender

PART I.
Personal information                                                        
Name (first, last) _______________________________________________
Name Called__________________________________________________ 
Address_____________________________________________________              
City, state, zip_________________________________________________
E-Mail address________________________________________________ 
Home telephone number_________________________________________ 
Sex     Male □        Female □
Race/Ethnicity (optional)_________________________________________
Country of Citizenship (if other than USA)____________________________

Academic Information
Current High School_________________________________
Current College, University, or Vocational School,
         accepted or enrolled in___________________________
Attended from____________to_________________
Year and Semester of PSECFI EducationalScholarship Fund applying for__________________

PART II.
Please list and briefly describe three activities, accomplishments, or passions that you think help to describe who you are.
1)_________________________________________________________________________

___________________________________________________________________________

2) _________________________________________________________________________

___________________________________________________________________________

3) _________________________________________________________________________

___________________________________________________________________________

PART III.
In an essay of no more than 500 words on a separate page, please respond to one of the following two questions.

1) Describe a project or issue in which you have successfully engaged others. Why were you passionate about this project of issue? How did you organize others to participate? How would you or will you continue to pursue this project or issue in college or vocational school?

2) “Only those who dare to fail greatly can ever achieve greatly” ---Robert Kennedy
Describe a time when you tired to lead and failed. What did you learn from this experience? What would you do differently?

PART IV.
Financial Data
Adjusted gross income of parents (Form IRS 1040)(if applicable) $______________
Applicants gross income (Form IRS 1040)$_____________Other source of income$_____________
School expenses for year of application: Tuition$_______Room/Board$__________Other$________
Money available for college expenses Parents$_______Work$_______Savings$_______Other______
Have you applied for student financial aid? □ Yes   □ No
           Please list amount of financial aid already secured $__________

RECOMMENDATION 1

Part V.
Because we will have access to the academic letters of recommendations in your Educational Scholarship Fund application, we ask that someone who is familiar with your extracurricular or community involvement complete this recommendation. We prefer that this be completed by an advisor or mentor (not a family member) who has direct knowledge of your leadership and/or your commitment to helping
Others.

To be completed by the candidate before giving to the recommender:

Student’s Name: __________________________________________________

E-Mail address: ___________________________________________________

Current School: ___________________________________________________


Under the Family Education and Privacy Act of 1974, which gives students the right to inspect and review their education records, students may waive their right to see specific confidential statements and letters of recommendation. Please check one of the options below.

I waive my right to examine this letter

I do not waive my right to examine this letter


• Attach and mail this letter with the application and give a copy of this letter to the recommender along with the Recommendation form


All applications, essays, & recommendation letters must be submitted and postmarked by June 1st to Piedmont Silver Eagles Charitable Funds, Inc., Educational Scholarship Fund, Capt. Stephanie Hamilton, 13115 Centennial Commons Parkway, Huntersville, NC 28078-4605


Signature of Applicant______________________________________

RECOMMENDATION 2

Part VI.

To be completed by the recommender:

Name________________________________________________________
Organization__________________________________________________
Mailing Address_______________________________________________
City, State, Country, zip_________________________________________
E-Mail Address________________________________________________

The Piedmont Silver Eagles Charitable Funds Educational Scholarship Fund is a scholarship based on merit. We seek students who have demonstrated leadership potential, and a commitment to community service, and whose behavior is grounded in strong ethical principal.

Please write a letter to help us better understand this student’s inspiration and motivation for his/her accomplishments. You may want to address this Candidates character, integrity, and life experiences.

How long have you known this student? __________________________________

In what capacity have you known this student? _____________________________

This form and the accompanying letter should be mailed and postmarked no later than June 1st to: Capt. Stephanie Hamilton, Piedmont Silver Eagles Charitable Funds, Inc., Educational Scholarship Fund, 13115 Centennial Commons Parkway, Huntersville, NC 28078-4605 (704) 766-0957
E-mail: scholarship@piedmontsilvereagles.org