Applicant Name: _____________________ BOY SCOUTS OF AMERICA MID- AMERICA COUNCIL KIT-KE-KAK-O-KUT LODGE #97 ORDER OF THE ARROW BOY SCOUT SCHOLARSHIP PROGRAM Please be sure to use only this form when applying. Application Deadline - Friday, October 31, 2⃝14 To ensure that your application is reviewed and processed as quickly and accurately as possible, please read and follow these procedures and requirements as written. Scholarships will be announced at the Winter Banquet, 6 December 2014. All scholarship checks will be mailed directly to academic institutions. All applicants must meet the following requirements: 1. Currently registered and active in a unit in the Mid-America Council. 2. Active/current dues paid member of Kit-Ke-Kak-O-Kut Lodge# 97 3. Currently enrolled or accepted for the Fall 2014 classes in a college/other institution of higher learning. 4. Complete a separate application for each scholarship applied for. Select one only. _____ Arrowman Scholarship* - A one (1) year scholarship in the amount of $400 awarded to one recipient. ____ Resident Camps Staff Scholarship* - A one (1) year scholarship in the amount of $500 awarded to one recipient. Additional requirements include: 1. Be an Eagle Scout at the time of application. 2. Serve during 2014 as a staff member of a Cub, WEBELOS, or Boy Scout Resident camp. ____ LEC Scholarship* - A one (1) year scholarship in the amount of $500 awarded to one recipient. Must be an Eagle Scout at the time of application. ____ Key 3 Scholarship* - A one (1) year scholarship in the amount of $500 awarded to one recipient. Additional requirements include: 1. Be an Eagle Scout at the time of application. 2. Be a Brotherhood member of the Order of the Arrow. ____ Chief’s Scholarship* - A one (1) year scholarship in the amount of $75⃝ awarded to one recipient. Additional requirements include: 1. Be an Eagle Scout at the time of application. 2. Be a Vigil member of the Order of the Arrow. *Applicatants are encouraged to attend the 2014 Winter Banquet Awards Banquet on 6 Dec 2014. Attendance at the event is not required to win a scholarship. Page 1 Applicant Name: _____________________ The Scout applying for a scholarship must: • • • • • • Complete the application personally. Enclose only the items requested in the requirements (no biographies, resumes, or supplementary lists of activities). Include the applicant's name on each attachment in the upper right hand corner. Must include letter of recommendation from school guidance counselor. Separate sheet(s) containing essay questions. Submit all supplemental information with the application form to ensure that all items are available for review at the same time. Address complete applications to: Order of the Arrow Scholarship, Mid-America Council, attn: OA Staff Adviser, 12401 W. Maple Rd., Omaha NE, 68164. All applications become the property of the OA /MAC Scholarship Committee. APPLICANT'S INFORMATION Please type or print in black ink. Name ____________________________________________________________Age _____________Date of Birth __________ (first I middle I last) Home Address _____________________________________________City ______________________State ____________Zip Home Phone Number ________________________________________ BSAID _____________________________ Father/Guardian ______________________________________________Daytime Phone Number ___________________________ Mother/Guardian ______________________________________________Daytime Phone Number ___________________________ Email Address ______________________________________ (One that is checked on a regular basis) SCOUTING RECORD I am currently registered in Troop/Team/Crew No. __________________________Current Position _______________________ Full name of Charter Partner ________________________________________ Years of Scouting __________ , Unit Leader _______________________________Phone # __________________Email ____________________________ _________________ Positions Held (Check all that apply.) ⃝ Senior Patrol Leader ⃝ Patrol Leader ⃝ OA Troop Representative ⃝ Den Chief ⃝ Crew President ⃝ Crew Officer ⃝ Secretary ⃝ Boy Scout Resident Camp staff Locations/years ⃝ Cub Resident Camp Staff Locations/years: ⃝ WEBELOS Camp Staff Locations/years: ⃝ Day Camp Staff Locations/years: ⃝ Other Positions Held: _____________ National Awards Earned (Check all that apply.) Order of the Arrow ⃝ 50 Miler Award ⃝ BSA Lifeguard ⃝ Den Chief Service Award ⃝ Historic Trails Award ⃝ Leave No Trace Award ⃝ Honor Medal with Crossed Palms ⃝ Honor Medal ⃝ Lodge chief ⃝ Heroism Award ⃝ Lodge Vice Chief/Officer Medal of Merit ⃝ Chapter Chief ⃝ Religious emblem(s) (list all): ⃝ Chapter Vice-Chief ⃝ Scuba BSA ⃝ Section Officer ⃝ Snorkeling BSA ⃝ Region Officer ⃝ William T Hornaday Award(s) ⃝ National Officer ⃝ Other _____________________ ⃝ ⃝ Eagle Scout ⃝ Palms earned: ⃝ Ordeal Date Brotherhood Date Vigil Date Founders Award Order of the Arrow Positions Date: ________ OA Committee(s) Venturing Award(s) (list all): year(s) Committee Name / / / / Page 2 Applicant Name: _____________________ Other Scouting positions/awards (Please specify.) Outdoor experiences of five or more days and nights (Please specify.) Have you served in a staff position for any of the following? (Check all that apply.) ⃝Philmont / High-Adventure Base ⃝National Jamboree ⃝World Jamboree ⃝Council Expeditions ⃝NYLT ⃝Order of the Arrow School Activities (Check all activities you have been involved in during high school) Sports Clubs and Other Activities ⃝ Baseball ⃝ Band/Orchestra ⃝ Future Business of America ⃝ Basketball ⃝ BETA ⃝ Future Farmers of America ⃝ Cross-Country Running ⃝ Boy's State ⃝ Knowledge Bowl ⃝ Cross-Country Skiing ⃝ Choir ⃝ Math ⃝ Downhill Skiing ⃝ Chess ⃝ Mock Trial ⃝ Football ⃝ Computer ⃝ Model UN ⃝ Golf ⃝ Debate ⃝ National Honor Society ⃝ Hockey ⃝ Drama/Theater ⃝ Science ⃝ Soccer ⃝ Foreign language ⃝ Students Against Drunk Driving ⃝ Swimming/Diving ⃝ History ⃝ Tutoring/Peer Counseling ⃝ Tennis ⃝ International ⃝ Yearbook/Magazine/Newspaper ⃝ Track ⃝ Key ⃝ Other (Please specify.) ⃝ Volleyball ⃝ Fellowship of Christian Athletes ⃝ Wrestling ⃝ Other (Please specify.) Please note any activities or awards you are especially proud of: Activities Outside of School and Scouting (Check all that apply.) Church Clubs and Other Activities Sports ⃝ Acolyte ⃝ Blood drives ⃝ Baseball ⃝ Altar ⃝ Civic (library, park, government, etc.) ⃝ Basketball ⃝ Choir ⃝ Community theater ⃝ Cross-Country ⃝ Deacons Quorum ⃝ Exchange student program ⃝ Football ⃝ Teachers Quorum ⃝ Food drives ⃝ Golf ⃝ Priests Quorum ⃝ 4-H ⃝ Hockey ⃝ Sports ⃝ Hospital ⃝ Martial Arts ⃝ Sunday School Teacher ⃝ Junior Achievement ⃝ Skiing-Alpine ⃝ Usher ⃝ Kiwanis ⃝ Skiing-Nordic ⃝ Youth group ⃝ Local Band ⃝ Soccer ⃝ Other (Please list) ⃝ Music ⃝ Swimming/Diving ⃝ Red Cross ⃝ Wrestling ⃝ ⃝ ⃝ ⃝ Rotary Salvation Army Tutoring Other (Please list) ⃝ Others (Please list) Page 3 Applicant Name: _____________________ SCHOOL INFORMATION (please complete this section and attach a recommendation letter from your school guidance consoler.) Name of High School/Preparatory School ______________________________________________________ Address _____________________________ City _____________________State _____Zip __________ Principal's Name _______________________________ Telephone________ Graduation Date:_________ SAT Score ______ and/or ACT Score ______________ Percentile Ranking ___________Your GPA ____________(Converted to 4.⃝ scale.) CAREER ASPPRIATIONS If I am selected. please send the scholarship directly to the following institution: Institution Name: Degree Program: Student Account/ID#: Mailing Address for Student Accounts: Address Student Accounts phone #: City / State / Zip Have you received or do you expect to receive other financial aid grants or scholarships? If so, please list names and amounts: _______________________________________________________________ $_____________________ _______________________________________________________________ $_____________________ On a separate sheet of paper, please type your answers to the following questions: What the Scouting program has meant to me? How the Scouting program has influence me in my life? What I hope to do within the next 5 years? What I hope to achieve upon completing my higher education? How will I pay for college? If you are applying and are an Eagle Scout, please provide a detailed description of your Eagle Scout service project. I hereby authorize the Order of the Arrow Scholarship Selections Committee to request and obtain any additional information it may deem necessary. On my honor as a Scout, all information and statements on this form are true and correct. ________________________________________________ __________________ Signature of Scout Applicant Date I have read the foregoing application and it has my approval. ________________________________________________ __________________ Signature of Parent/Guardian Date Page 4
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