Educational Opportunity Scholarship Form

Full Legal Name (Required)

Other Name

Email

Applicant’s Home Phone

Applicant’s Cell Phone

Gender

Are You a Veteran, Active Duty, Reserves or National Guard?

CA SSID Number

ELC Number

Date and Place of Birth (Required)

Permanent Address

Current Mailing Address (Required)

Parent/Guardian As the Primary Contact to Whom Correspondence will be Sent. (Required)

In case of blended or divided family, please provide spouse information with Name and Relationship to Applicant.

Parent’s Home Phone

Parent’s Work Phone

Parent’s Cell Phone

Parent’s Email

Preferred Method of Correspondence via: Mail, Phone, Email (Required)

Lived in California for at least 12 months?

If not 18, parent/guardian lives in California?

Is any relative, parent, guardian, or spouse an employee at a Private or Boarding High School or College Educational Institution? If so, give name, relationship and school.

Is any relative or friend of the candidate presently or previously associated with a Private or Boarding High School? If so, give name, relationship and school.

Currently attend a California High School/College, or have attended for 2+ years?

Language Spoken First (At Home)

Country of Citizenship

Country of Permanent Residence (Non-US Citizens)

Citizenship Status (Non-US Citizens)

International Students: Do you require an I-20 form to obtain a student visa?

Applying for High School (Boarding, Private) or College for What Year?

Graduation Year

College- Campus Choices
List Your Choices of College, Campus/Major-Alternate Major (Required)

Apply for Scholarships? If so, Which ones.

Apply for EOP?

Family Data
Current Occupation for Father / Parent 1 / Guardian (Required)

Prior Occupation for Father / Parent 1 / Guardian

Current Occupation for Mother / Parent 2 / Guardian (Required)

Prior Occupation for Mother / Parent 2 / Guardian

Are student applicants’ parents separated, divorced, or have never been married. If separated, give court action, or if Legally separated, is there a joint custody agreement, and give the Year of divorce/separation? (Required)

Dependent Students: Parents’ Annual Income and Family Size.

Independent Students: Student’s Annual Income and Family Size.

Siblings: Name, Age, Current School for Sibling(s)

Child support received for all children.

Social security benefits for entire family. (Required)

Estimate the amount available from each source to pay tuition and educational expenses for the academic year for student applicant:

Parent or Guardian

Financial aid award

Loan

Student’s assets & earnings

Friends, relatives, trust funds, & other sources, Please Explain.

Social Services

Have/will apply for aid?

Educational Expenses:
How many children will be attending full-time childcare, tuition-charging preschools, schools, or colleges this year?

How many children, including the student applicant(s), are/will be receiving support from you this year?

Unusual expenses:

State of Legal Residence for Legal Guardian/Spouse (Required)

Parents’ Education

Foster Care Status

Academic History
Institution 1
High School Graduated From

Dates of Attendance

Current or Most Recent School Attended

Term Type (Quarter, Semester, Year-Round, Other)

Specialized Curriculum

Grading System (A-F, P/NP, Descriptive, Other)

School Certification

High School Counselor’s Name

High School Counselor’s Address

High School Counselor’s Work Phone

High School Counselor’s Cell Phone

High Shcool Counselor’s EMAIL

Institution 2
High School Graduated From

Dates of Attendance

Current or Most Recent School Attended

Term Type (Quarter, Semester, Year-Round, Other)

Specialized Curriculum

Grading System (A-F, P/NP, Descriptive, Other)

School Certification

High School Counselor’s Name

High School Counselor’s Address

High School Counselor’s Work Phone

High School Counselor’s Cell Phone

High Shcool Counselor’s EMAIL

Institution 3
High School Graduated From

Dates of Attendance

Current or Most Recent School Attended

Term Type (Quarter, Semester, Year-Round, Other)

Specialized Curriculum

Grading System (A-F, P/NP, Descriptive, Other)

School Certification

Academic History
Years Spent in Each Grade Level 12th Grade, 11th Grade, 10th Grade, 9th Grade, 8th Grade, 7th Grade, 6th Grade

Country of Instruction

Language of Instruction

Gaps in Education

6th Grade Coursework (List Course Title, Honors, School, Term, Grade)

6th Grade School and Address

6th Grade Principal’s Name

6th Grade Counselor’s Name

6th Grade Counselor’s Work Phone

6th Grade Counselor’s EMAIL

History

Social Science

English

Mathematics

Laboratory Science

Language Other Than English

Visual and Performing Arts

GRADE POINT AVERAGE

CLASS RANK

7th Grade Coursework (List Course Title, Honors, School, Term, Grade)

7th Grade School and Address

7th Grade Principal’s Name

7th Grade Counselor’s Name

7th Grade Counselor’s Work Phone

7th Grade Counselor’s EMAIL

History

Social Science

English

Mathematics

Laboratory Science

Language Other Than English

Visual and Performing Arts

GRADE POINT AVERAGE

CLASS RANK

8th Grade Coursework (List Course Title, Honors, School, Term, Grade)

8th Grade School and Address

8th Grade Principal’s Name

8th Grade Counselor’s Name

8th Grade Counselor’s Work Phone

8th Grade Counselor’s EMAIL

History

Social Science

English

Mathematics

Laboratory Science

Language Other Than English

Visual and Performing Arts

GRADE POINT AVERAGE

CLASS RANK

9th Grade Coursework (List Course Title, Honors, School, Term, Grade)

9th Grade School and Address

9th Grade Principal’s Name

9th Grade Counselor’s Name

9th Grade Counselor’s Work Phone

9th Grade Counselor’s EMAIL

History

Social Science

English

Mathematics

Laboratory Science

Language Other Than English

College Prep Electives

Visual and Performing Arts

GRADE POINT AVERAGE

CLASS RANK

10th Grade Coursework (List Course Title, Honors, School, Term, Grade)

10th Grade School and Address

10th Grade Principal’s Name

10th Grade Counselor’s Name

10th Grade Counselor’s Work Phone

10th Grade Counselor’s EMAIL

History

Social Science

English

Mathematics

Laboratory Science

Language Other Than English

College Prep Electives

Visual and Performing Arts

GRADE POINT AVERAGE

CLASS RANK

11th Grade Coursework (List Course Title, Honors, School, Term, Grade)

11th Grade School and Address

11th Grade Principal’s Name

11th Grade Counselor’s Name

11th Grade Counselor’s Work Phone

11th Grade Counselor’s EMAIL

History

Social Science

English

Mathematics

Laboratory Science

Language Other Than English

College Prep Electives

Visual and Performing Arts

GRADE POINT AVERAGE

CLASS RANK

12th Grade Coursework (List Course Title, Honors, School, Term, Grade)

12th Grade School and Address

12th Grade Principal’s Name

12th Grade Counselor’s Name

12th Grade Counselor’s Work Phone

12th Grade Counselor’s EMAIL

History

Social Science

English

Mathematics

Laboratory Science

Language Other Than English

College Prep Electives

Visual and Performing Arts

GRADE POINT AVERAGE

CLASS RANK

GED Coursework (List Course Title, Honors, School, Term, Grade)
History

Social Science

English

Mathematics

Laboratory Science

Language Other Than English

College Prep Electives

Visual and Performing Arts

GRADE POINT AVERAGE

CLASS RANK

Junior College/Freshman Coursework (List Course Title, Honors, School, Term, Grade)
History

Social Science

English

Mathematics

Laboratory Science

Language Other Than English

College Prep Electives

Visual and Performing Arts

GRADE POINT AVERAGE

CLASS RANK

Junior College/Sophomore Coursework (List Course Title, Honors, School, Term, Grade)
History

Social Science

English

Mathematics

Laboratory Science

Language Other Than English

College Prep Electives

Visual and Performing Arts

GRADE POINT AVERAGE

CLASS RANK

Test Results
SSAT

ISEE

PSAT

ACT Assessment

SAT Reasoning Test

SAT Subject Tests-
Literature: Score

Mathematics Level 2 (formerly Math IIC): Score

Foreign Language: Score

Advanced Placement Classes

International Baccalaureate Diploma

International Baccalaureate Exams

TOEFL or IELTS Score

Have you completed your PFS application and sent copies of any letters, tax forms, or other supporting documentation directly to School and Student Services By NAIS?

Medical History
Have you ever been diagnosed as having a learning disability, ADHD, ADD, BiPolar, Tourette’s Syndrome, Dyslexia, Behavioural Problems, Psychiatric illness, or any other? If yes, please elaborate.

Have Your difficulties been formally identified through the health board disability services? If Yes please elaborate

Do You Receive Any Support/Assistance from Any Services for These Concerns? If yes, please elaborate.

Are You on Any Type of Medication? If yes, please give details.

Are you able to perform the essential functions of the task for which you are applying, either with/without reasonable accommodation? If no, describe the functions that cannot be performed. (Note: Some companies/institutions comply with the ADA standards and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)

Are you aware of any serious physical health problem you may currently be suffering from or have suffered from in the past? If yes please elaborate.

Do you now or have you ever experienced any of the following:
Chest Pains; Daily Coughing; Chest Pressure; Fainting; Palpitations/skipped beats; Seizures; Unexplained weight change; Disorientation; Difficulty Walking; Numbness or tingling; Allergies; Frequent Loss of Balance, Excessiveness shortness of breath with exercise; Frequent Headaches; Dizziness? If yes please elaborate.

Do you have or did a physician ever diagnose you as having any of the following:
Heart Disease, Diabetes, Heart Murmur, Emphysema, Arrhythmia’s, Asthma, Circulatory Problems, Chronic Bronchitis, High Blood Pressure, Vertigo. Neurologic Problems, High Cholesterol, Arthritis, Osteoporosis, Cancer, Condition(s) not listed? If yes please elaborate.

Are you presently under a physician’s care for any of the above, or for any other condition? If YES, please provide type of treatment you are receiving and your physician’s name, address and phone.

Activities & Awards
Academic Awards & Honors List Name, Type, Date, Description

Extracurricular Activities 1 List Name, Type, Years Involved, Hours/Week , Weeks/Year, Date, Description

Extracurricular Activities 2 List Name, Type, Years Involved, Hours/Week , Weeks/Year, Date, Description

Community Service 1 List Name, Type, Years Involved, Hours/Week , Weeks/Year, Date, Description

Community Service 2 List Name, Type, Years Involved, Hours/Week , Weeks/Year, Date, Description

Community Service 3 List Name, Type, Years Involved, Hours/Week , Weeks/Year, Date, Description

Community Service 4 List Name, Type, Years Involved, Hours/Week , Weeks/Year, Date, Description

Educational Preparation Programs 1 List Name, Type, Years Involved, Hours/Week , Weeks/Year, Date, Description

Educational Preparation Programs 2 List Name, Type, Years Involved, Hours/Week , Weeks/Year, Date, Description

Educational Preparation Programs 3 List Name, Type, Years Involved, Hours/Week , Weeks/Year, Date, Description

Work Experience 1 List Position, Years Involved, Start/End Date, Hours/Week, Job Responsibilities

Work Experience 2 List Position, Years Involved, Start/End Date, Hours/Week, Job Responsibilities

Work Experience 3 List Position, Years Involved, Start/End Date, Hours/Week, Job Responsibilities

Work Experience 4 List Position, Years Involved, Start/End Date, Hours/Week, Job Responsibilities

What Did/Do You Do With Your Earnings? Explain

Coursework Other Than Listed Above

ATHLETIC SPORTS INFORMATION
ALL SPORTS PLAYED

POSITION

HEIGHT and WEIGHT

ATHLETIC HONORS

High School COACH’S NAME

High School COACH’S Address

High Shcool COACH’S EMAIL

High School COACH’S CELL PHONE

High School COACH’S WORK PHONE

AAU CLUB TEAM NAME

AAU CLUB COACH’S NAME

AAU CLUB COACH’S Address

AAU CLUB COACH’S EMAIL

AAU CLUB COACH’S CELL PHONE

AAU CLUB COACH’S WORK PHONE

FOR HIGH SCHOOL APPLICANTS
Personal Statement/Writing Sample
Please discuss two of the following questions in your own writing in a minimum of 100 words for each question.

1. What do you consider to be the general advantages of attending a Boarding or Private High School?

2. What do you consider to have been the most difficult course you have taken, why was it challenging, and what did you learn from the adversity that provides you any advantages in school and life?

3. What do you consider to be your strongest quality, unusual strengths, talents, capacity for leadership and in what manner do you hope to contribute to the high school environment?

4. Please tell us about an important experience or about a person who has influenced your life.

5. What do you consider to be your greatest weaknesses or problems of which you are aware and how do you expect to overcome them? Are there special or unusual circumstances (positive or negative) which may be relevant to your performance in school?

6. To what extent have you made use of your full academic potential considering your intellectual abilities, academic work, interests, motivation, originality, promptness, organization, and genuine interest in academic pursuits?

7. Describe yourself given the aspects of : Aptitude for Subject, Study Habits, Enthusiasm, Achievement, Originality, Reasoning Ability, Motivation, Integrity, Self-Discipline, Perseverance, Concern for Others, Reaction to Criticism, Respect from Faculty, Tolerance for Others, Common Sense, Imagination, Leadership, Peer Compatibility, Sense of Humor, Self-Esteem, Independence, and Maturity.

8. What do others say about your academic performance, personality strengths and weaknesses, potential for growth, relationship with your peers and adults, your talents, and areas in which they would expect you to contribute most to Boarding or Private High School?

Response No.1 (Required)

Response No.2 (Required)

FOR COLLEGE APPLICANTS
Personal Statement/Writing Sample
Please discuss two of the following questions in your own writing in a minimum of 100 words for each question.

1. What do you consider to be the general advantages of your attending College, what and how would it differ if you did not attend College?

2. What do you consider to have been the most difficult course you have taken, why was it challenging, and what did you learn from the adversity that provides you any advantages in College and life?

3. What do you consider to be your strongest quality, unusual strengths, talents, capacity for leadership and in what manner do you hope to contribute most to the College environment?

4. Please tell us about an important experience or about a person who has influenced your life.

5. What do you consider to be your greatest weaknesses or problems of which you are aware and how do you expect to overcome them? Are there special or unusual circumstances (positive or negative) which may be relevant to your performance in College?

6. To what extent have you made use of your full academic potential considering your intellectual abilities, academic work, interests, motivation, originality, promptness, organization, and genuine interest in academic pursuits?

7. Describe yourself given the aspects of : Aptitude for Subject, Study Habits, Enthusiasm, Achievement, Originality, Reasoning Ability, Motivation, Integrity, Self-Discipline, Perseverance, Concern for Others, Reaction to Criticism, Respect from Faculty, Tolerance for Others, Common Sense, Imagination, Leadership, Peer Compatibility, Sense of Humor, Self-Esteem, Independence, and Maturity.

8. What do others say about your academic performance, personality strengths and weaknesses, potential for growth, relationship with your peers and adults, your talents, and areas in which they would expect you to contribute most to College?

Response No.1 (Required)

Response No.2 (Required)

Please feel free to make additional comments that will assist the Admission Committee with their final decision.

Additional Comments: Use this space to explain all items that you feel need more consideration and any unusual circumstances or expenses. Schools may deny admissions or be unable to grant financial assistance without an explanation of some critical items.

Applicants whose applications are complete by January 1 will receive notification of a decision by April 10. Later applicants will be reviewed as their applications are completed and will be subject to space availability. All School admit students of any race, creed, color, and national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. They do not discriminate on the basis of race, color, disability, national and ethnic origin in administration of its educational policies, admission policies, scholarship and loan programs, and athletic and other school-administered programs.

You declare that the information reported on this form, to the best of your knowledge and belief, is true, correct, and complete. You recognize that intentionally providing false or inaccurate data may impact your ability to receive any financial aid and/or your ability to maintain a contract with a school. You authorize transmittal of this form and the information within it to the schools and organizations for their consideration of admission and financial aid and its use by those schools and organizations and their third party service providers. The third party service providers, and any of the schools and organizations designated by us to receive copies of this information have your permission to verify the information reported, and you understand and agree that this verification may include the disclosure of personal and financial information, such as an official copy of your latest income tax return and/or a signed IRS Form 4506. If you do not agree to the above, please do not submit this Educational Opportunity Form. By submitting this form, you authorize us to utilize the information in the aforementioned manner.

Thank you for completing the Educational Opportunity Application. Be assured that the information we have requested is essential to our understanding and how best to satisfy your current request and future needs, and that it will remain completely confidential. Please watch for an e-mail from us after we have reviewed your request.

I Accept the Aaron and Margaret Wallace Foundation’s Terms of Submission. (Required)