Crystal Coast Officials Association (CCOA) Scholarship Application Cover Sheet Please note that all applicants must be high school senior student athlete who will successfully complete graduation requirements in the spring of the current school year (2014 spring graduation), and must be planning to enroll, or already be enrolled, for the fall 2014 semester (following spring graduation) in an accredited, recognized university, college, or community college anywhere in the United States. Scholarship funds will be used to further scholarship recipients’ educational endeavors. Provide the Following with Your Application Fill out the Scholarship Application Form. Attach additional sheets if you run out of space. Compose a thoughtful personal statement (maximum two double-spaced pages, size 12 font) which will help committee members learn about your personal history, perspectives, goals and interests. Be sure to include your education plans and career goals. This is a very important part of the application as it assists committee members in gaining a sense of who you are. Please request and submit one (1) official transcript from your high school. Request a letter of recommendation from a coach, teacher, guidance counselor, or school administrator. This person will also serve as the point of contact between CCOA and your school. Letters from parents, friends and relatives will not be accepted. Compile the Application Packet. Please submit original, unstapled, complete application packet. Include the following attachments in the following order:     Scholarship Application Form (4 pages) Personal statement One official transcript from your high school One letter of recommendation (ask recommendation writers to seal letter and sign the letter across the sealed flap of an envelope). Please submit this in your packet, sealed.  One Self-addressed, #10 Business-size envelope with current first class postage properly affixed Application packages must be postmarked no later than 30 April 2014. Only complete application forms, with all documentation, will be processed. Mail application package to: Crystal Coast Officials Association P O Box 103 Havelock, NC 28532 Applicants will be notified of their final status by 1 August 2014 at the mailing address in the application. If selected, once you have your college identification number and/or student cashier account number, please contact CCOA with this information so that scholarship funds can be issued directly to your qualifying school of choice. Crystal Coast Officials Association (CCOA) Scholarship Application Form APPLICANT INFORMATION Name: __________________________________________________________________ FIRST MIDDLE LAST Address: __________________________________________________________________ STREET ADDRESS APT # CITY STATE ZIP Home phone (with area code): ______________________ Cell Phone __________________ Date of birth: _________________ E-mail address: _____________________________________________________________ ACADEMIC INFORMATION Graduating Senior (will complete graduation requirements spring 2012)? Yes No High School: ________________________________________________________ County: ______________________________ Cumulative Grade Point Average (GPA): _____________ College/university/community college you plan to attend in Fall 2012: ________________________________________________________________________________ Have you been accepted? Yes Not yet What will be your field of study? _______________________________________________________ Provide the following information on the person from your school (coach, teacher, guidance counselor, or school administrator) serving as your point of contact between the CCOA and school. This person has also agreed to write a letter of recommendation on your behalf as outlined in Section 2 of the Cover Sheet. Contact Name: __________________________________ Title: ____________________________________ ~1~ High School: _____________________________________________________________________________ Phone Number: (_____) __________________ Cell Phone (_____) _________________________________ Email: ________________________________________________________________ Signature: ________________________________________________________ Date: __________________ ATHLETIC PARTICIPATION List any athletic participation on school-sponsored, athletic teams during high school career. Grade 9 Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Grade 10 Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Grade 11 Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Grade 12 ~2~ Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ Sport _____________________________ Awards/recognition _________________________ VOLUNTEER EXPERIENCE List community volunteer activities you have participated in during your high school career Activity/Organization ~Start Date ~End Date ~Hours per week ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Special talent or marketable skill you would like to develop: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ List any of your hobbies, activities and/or interests: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ~3~ List any special recognition or awards you have received: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ How did you learn about our scholarship offerings? ________________________________________________________________________________ APPLICATION CERTIFICATION I hereby affirm that the information provided on this form is accurate and complete to the best of my knowledge ________________________________________________________________________________ APPLICANT SIGNATURE DATE ~4~