A. Applicant Information
This is a sample application. Paper applications will not be accepted.
Nickname
Full Name
Home Address
City
Cell
Phone Number
Date of Birth
Gender
State
Zip
Email Address
Country of Birth
Ethnicity (optional)
Are you a US Citizen?
Are you a US Legal Resident?
Were you born in Arizona?
Have you traveled outside the U.S.?
If yes, to what country(s)?
Please explain your purpose for travel:
B. Family Information
Does anyone living at your home address have a bachelors degree or higher?
Please list the adults (other than siblings) who live at your home address.
Full Name
Gender?
What is your relationship to this person?
Highest level of education?
Occupation
Employer (Company Name)
Full Name
Gender?
What is your relationship to this person?
Highest level of education?
Occupation
Employer (Company Name)
Please list the Parents/Guardians who do not live at your home address.
Full Name
What is your relationship to this person?
Highest level of education?
Occupation
Employer (Company Name)
Gender?
Dorrance Scholarship Application
Application Deadline: February 22, 2013
Full Name
Gender?
What is your relationship to this person?
Highest level of education
Occupation
Employer (Company Name)
Number of siblings?
Please list the names, ages, school/college and grade level for each of your siblings.
Name
Age
School/College
Has anyone in your family received a Dorrance scholarship?
If “yes,” what is (are) their name(s)?
C. Academic Information
Arizona High School
School City
School State
List the Arizona universities to which you have applied.
List the Arizona university you plan to attend.
Have you been admitted?
If “yes,” what is your university ID number?
Have you ever visited or toured the university of your choice?
Have you applied out-of state?
Proposed career choice?
Proposed college major?
If so, list your top three schools.
Grade Level
Dorrance Scholarship Application
Application Deadline: February 22, 2013
List the fall course you have taken and the grades you received; and the spring courses you are currently taking.
Fall Semester Courses
Grade (A-F)
Spring Semester Courses
1
D. School Activities
List any school activities you have participated in within the last four years. If you do not have enough room to list all of your
achievements, please prioritize and list only what you consider to be the most important (15 words for each activity).
Activity
Hrs. Invested
per Year
Discuss the school activity that is most important to you and why. One paragraph (250 words).
Years Participated
Dorrance Scholarship Application
Application Deadline: February 22, 2013
Tell us about any significant hobbies, interests or experiences that are important to you but were not listed above (75 words).
Have you been placed on probation, suspended from school or any program, or formally charged with a crime in a court of
law?
If “yes,” please explain. (50 words)
E. Employment History
List jobs you have had (including summer employment) within the last four years.
Job/Kind of Work
If you worked during the school year, explain why (50 words).
Employer
Dates
Hrs. Worked/Week
Dorrance Scholarship Application
Application Deadline: February 22, 2013
F. Volunteer Service Activities
List any volunteer activities you have participated in within the last four years. If you do not have enough room to list all of your
achievements, please prioritize and list only what you consider to be the most important (15 words for each activity).
Activity
Hrs. Invested
Years Participated
per Year
What is the value of community service? Discuss the volunteer service that is most important to you and why. Does your
service fulfill a school or church requirement? Why did you become involved with this organization? One paragraph (250
words).
Dorrance Scholarship Application
Application Deadline: February 22, 2013
G. Short Essays and Personal Statements
This part of the application enables the selection committee to learn more about you. In addition to your ideas and thinking, we will
also evaluate the quality and content of your essay.
1. Snap Shots
Respond to each of the following (one word might suffice). There is no right or wrong answer. Have fun!
 Your email address
 A word that describes you
 Most prized possession
 Favorite food
 Favorite book you’ve read
for pleasure
 Favorite musical band/
performer / composer
 Dream job
 Role model
 Best movie of all time
 Whose face would you
add to Mt. Rushmore
 Rank the following in order of their
influence on your education. One
being the most influential, four
being the least influential.
Video Games
Books
Computer
Television
 The Dorrance Scholarship is a program with many benefits. If you are selected, what part of the program do you think you will
enjoy most and why? (150 words)
 What is the biggest challenge that your generation will face? Tell us your idea on addressing this issue (don’t focus on current
capabilities; assume all knowledge and resources are available to you) (250 words).
Dorrance Scholarship Application
Application Deadline: February 22, 2013
Dorrance Scholarship Application
Application Deadline: February 22, 2013
2. Essay
The essay portion of the application will only be required if an applicant is selected as a semi-finalist.. Students will be notified
if they have or have not been selected as a semi-finalist via email by March 6, 2013. The prompt will be announced at that
time.