COMMUNITY FOUNDATION OF NORTH TEXAS CHESAPEAKE SCHOLARSHIP FUND INSTRUCTIONS FOR SCHOLARSHIP RECIPIENTS The Chesapeake Scholarship Fund was established in Community Foundation of North Texas throuqh a contribution by Chesapeake Energy. The goal of the Scholarship is to' make a college degree or vocational certification possible for minority and socially disadvantaged youth. In order for recipients to receive benefits of the scholarship, it is essential that they take the following actions: 1. Notify Community Foundation of North Texas at the followinq address by August 1st on the first year of the scholarship, the name of the college or university to which they have been accepted so that the funds for the first semester may be sent to the college or university to be credited to their account. Community Foundation of North Texas, 306 West Seventh Street, Suite 306, Fort Worth, Texas 76102. Telephone 817-877-0702. 2. By March 15th of each succeeding year re-apply by letter to the Community Foundation of North Texas for the succeeding year's scholarship. A copy of the student's grade transcript for the preceding semester should accompanythe application. 3. By August 1st of each succeeding year, forward a copy of the student's grade transcript to Community Foundation of North Texas along with a letter stating their plans for attending the next succeeding year so that a check may be sent to the college or university in a timely manner. Rev. 12/20/20078:47:35 AM IBLANK FORM MAY BE DUPLICATEg COMMUNITY FOUNDATION OF NORTH TEXAS CHESAPEAKE SCHOLARSHIP FUND The Chesapeake Scholarship Fund was established in Community Foundation of North Texas through a contribution by Chesapeake Energy. The goal of the Scholarship is to make a college degree or vocational certification possible for minority and socially disadvantaged youth. Initially, the Scholarship will be offered to graduating seniors of a Fort Worth Independent School District High School. The value of the scholarship will depend on financial need up to $20,000. Recipients of the scholarship may reapply in each of the succeeding three years. To be considered for the scholarship award, students must submit an application along with the following required documents to COMMUNITY FOUNDATION OF NORTH TEXAS, 306 West Seventh Street, Suite 306, Fort Worth, Texas 76102 by MARCH 1ST• 1. Certified high school transcript showing GPA and class rank. 2. A copy of the completed Free Application for Federal Student Aid (FAFSA) or the completed Student Aid Report (SAR). 3. A typed essay of no more than 500 words desc ~ibing motivations and obstacles in pursuing higher education. 4. On one attached page, describe: EXTRACURRICULAR ACTIVmES you have participated in during the past four years, such as student government, sports, and clubs, including offices held and any special honors you have received. COMMUNITY SERVICE activities in which you have participated in the past four years, including the number of hours per week spent on the activity and how many days, months, or years you have participated in the activity. WORK EXPERIENCE you have had in the past four years, including your length of employment, the number of hours you worked and how much you earned. 5. At least one, but no more than three LETTERS OF RECOIVII"1ENDATIOI'J written on your behalf by persons not related to you (such as teachers, counselors and supervisors). Each of your references should include a telephone number where he or she can be reached during the business day. It is the responsibility of each scholarship applicant to submit all of the required items on or before the application deadline of March 1st . Due to the volume of scholarship applications, Community Foundation cannot assemble items that are missing from applications. For that reason, INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. Rev. 12/19/20079:04:17 AM IBLANK FORM MAYBE DUPLICATEij CHESAPEAKE SCHOLARSHIP APPLICATION The Chesapeake Scholarship Fund was established in Community Foundation of North Texas by Chesapeake Energy. The goal of the Fund is to make a college degree or vocational certification possible for minority and socially disadvantaged youth. If you meet the eligibility criteria below, please submit the completed application to: Community-Foundation of North Texas 306 West Seventh Street, Suite 306 Fort Worth, Texas 76102 APPLICATIONS MUST BE SUBMITTED BY MARCH 1ST, ELIGIBILITY -You are eligible to apply for a Chesapeake Scholarship if you satisfy the following criteria: 1. Applicant must be a graduating senior of a Fort Worth Independent School District high school. 2. Applicant must have a minimum GPA of 3.0. 3. Applicant must be accepted by an accredited college, university or vocational school. 4. Applicant must be a U.S. citizen or legal resident of Tarrant County. 5. Applicant must be female or a member of a minority group as defined by the DFW Airport M/WBE Program. The term minority generally includes the following groups: American Indians, Aleuts, Asian-Pacific Americans, African Americans, Eskimos, Hispanic Americans, Native Hawaiians, and Subcontinent Asian Americans. 6. Applicant must submit a written essay of no more than 500 words describing motivations and obstacles in pursuing higher education. CONTACT rNFORMATION STUDENT NAME: Mr./Ms. First MI Last BIRTHDATE: PERMANENT ADDRESS: _ Street Add ress City State ZIP Telephone Chesapeake Scholarship Application [BLANK FORM MAYBE DUPLICATEq Page Iof 3 Rev. 12/19/2007 9 0342 AM HIGH SCHOOL INFORMATION HIGH SCHOOL: _ Name Telephone GRADUATION DATE (MO./YEAR): _ GPA: CLASS SIZE: _ CLASS RANK: ACT SCORE: SAT SCORE: (You must have taken either one of these two tests in order to apply. If you took a test more than once, you may use your highest score.) CO LLEGE INFORMAn ON: CO LLEGE OR UNI VERSITY OR VOCATION SCHOOL FOR WHICH YOU ARE REQ UESTING AID : List below the name of the school for which you are requesting aid, along with the location, the cost of attending that school, and whether or not you have been accepted. The financial aid office at the school should be able to provide you with this cost. The cost includes tuition and fees, on-campus room and board (or a housing and food allowance for off-campus students), and allowances for books and other expenses. If you have not decided which school you will attend, rank in order of preference. SCHOOL CITY, STATE COST PER YEAR ACC EPTED 1. 2. 3. FINANCIAL INFORMATION CHECK: __ I have applied for federal or state student financial aid. __ I intend to apply for federal or state student Financial aid. __ I do not intend to apply for federal or state student financial aid. ANNUAL FAM ILY INCOME: $-------(for the twelve months prior to January 1) PARENTS ' MARITAL STATUS Married Divorced Separated Widowed NUMBER IN HOUSEHOLD INCLUDING PARENTS: _ NUMBER OF IMM EDIATE FAMILY MEMBERS ATTENDINGCOLLEGETHIS cosnxo SCHOOLYEAR: Chesapeake Scholarship Application IBLANK FORM MAY BE DUPLICATEq Page2 of 3 Rev. 12119/2007903:42 AM FUNDS AVAILABLE FOR YOUR NEXT YEAR OF COLLEGE: Family contribution $ _ Personal savings/ earnings $_' _ Scholarships awarded $ _ Loans $ ---- Other $ ---- TOTAL $ _ Please send the attached Financial Information Survey to the financial aid office of the college(s) you will attend and ask them to return the form to Community Foundation of North Texas by March I ". We must have the Survey form available to us to review your scholarship application . It is your responsibility to check with the financial aid office to ensure that they send the information on time. Chesapeake Scholarship Application IBLANK FORM MAYBE DUPLICATEg Page3of 3 Rev, 12/19/2007 9:034 2 AM CHESAPEAKE SCHOLARSHIP FINANCIAL INFORMATION SURVEY TO THE SCHOLARSHIP APPLICANT: Please provide the following information before taking this form to the Student Financial Aid Office: I authorize to release the information requested to CommunityFoundation ofNorthTexas for consideration duringthe scholarship selection process. Name of Student Address Social Security Number Phone Student's Signature Date TO THE FINANCIAL AID OFFICE: Thestudentnamed above isapplyingfor a Chesapeake Scholarship from Community Foundation ofNorth Texas. Please complete the following information and send directly to: Community Foundation of North Texas 306 West Seventh Street, Suite 306 Fort Worth, Texas 76102 Phone 817-877-0702 FAX 817-877-1 215 The Scholarship Advisory Committee thanks you for your assistance and requests that this form be returned before March I", FAX copies are acceptable if signed by the person completing the form . All information should reflect the figures applicable for the upcoming academic year. 1. College Cost/Budget $--- 2. Parent Contribution $---- 3. Student Contribution $---- 4. Calculated Need $---- 5. This student was evaluated as a _ _ dependent or _ _ independent student. 6. Does this student demonstrate need under Federal Methodology?__Yes _ _ No Chesapeake Scholarship Financial Information Survey IBLANK FORM MAY BE DUPLlCATEg Page I of2 Rev. 12/19120079:04 02 AM 7. Do you believe that there are special circumstances that would warrant special consideration? Please explain. 8. Package offered: Gift aid: Scholarships $ Grants s Other $ Other aid Government Loans: s Institutional Loans s Work Study s Other s 9. Total financial aid offer $ 10. Unmet need (need minus aid) s 11. This financial aid package information is based on:_ _ estimated or _verified information. 12. Person completing form : Name Title CollegelUniversity _ Address Tel ephone _ E-mail _ Signature Chesapeake Scholarship Financial Information Survey [BLANK FORM MAY BE DUPLICATEij Page 2 of2 Rev. 12/19/2007 9:04:02 AM