AGUSTIN A. RAMIREZ, JR. FAMILY FOUNDATION SCHOLARSHIP PROGRAM
REQUEST FOR APPLICATION - For Students Already in College, but Applying for the first time
The Agustin A. Ramirez, Jr. Family Foundation Scholarship Program
HUSCO International
P.O. Box 257
Waukesha, WI 53187-0257
Phone: (262) 513-4200
To apply for the Agustin A. Ramirez, Jr. Family Foundation Scholarship, please complete the application and
return it to the Scholarship Coordinator at the above address. The Scholarship Coordinator must receive your
completed application no later than April 24, 2015 in order to be considered for the current school year awards.
Late applications will not be accepted.
Please type or print legibly.
Name: ___________________________________________________________________________
(Last)
(First)
(Middle)
Home Address: ____________________________________________________________________
(Street)
(City)
(State/Zip)
Applicant Eligibility - Check all that apply
___
Hispanic graduate of Greater Milwaukee Standard Metropolitan Statistical Area or Waukesha County high
school
____
Graduate of school that is a member or partner of Schools That Can Milwaukee
____
Graduate of UCC or Rocketship
___
Child of a full-time employee of HUSCO International
___
Other Foundation eligible category
APPLICATION CHECKLIST
All items below must arrive by the deadline.
Application Items
___ Request for Application Form
___ Application for Scholarship Form
___ Scholarship Recommendation Form
___ Essay
___ Official Transcript(s)
1. High School (include copy of SAT and/or ACT scores), AND
2. College
___ Evidence of Enrollment in College (if changing colleges this year)
___ Two Letters of Recommendation from the following:
1. College educational staff
2. College coaching staff
3. Your own choice
(Total letters = 2)
Explanatory Comments, (if any):
New-Already in College
1
AGUSTIN A. RAMIREZ, JR. FAMILY FOUNDATION SCHOLARSHIP PROGRAM
APPLICATION FOR SCHOLARSHIP
The Agustin A. Ramirez, Jr. Family Foundation Scholarship Program
HUSCO International
P.O. Box 257
Waukesha, WI 53187-0257
Please be sure to complete all pages of this application.
Name __________________________________________________________________________________
Last
First
Middle
Home Address
_______________________________________________________________________________________
Street
Phone # (
)
City
State
E-Mail:
Zip Code
D.O.B:
If you are applying as a child of a full-time HUSCO employee (qualifying parent must have completed at least three
years of full-time service with HUSCO International), please complete the following:
Name of parent:
Home address of parent:
I. About Your College / University Career:
A.
College/University ___________________________________________
Address ___________________________________________________
Street
______________________________________________________________________
City
State
Zip Code
Dean or Faculty Member Name: ____________________________Phone No. (____)_________
Date of attendance: From ____________ To ___________
When will you graduate? ____________________________
Other colleges/universities attended: ____________________________________
Dates of attendance _________________________________________________
B.
Attach a recent official transcript showing classes taken, grades, and any advanced placement or honors
courses.
C.
Please indicate any special honors or recognition received during your college years.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
2
New-Already in College
AGUSTIN A. RAMIREZ, JR. FAMILY FOUNDATION SCHOLARSHIP PROGRAM
Name of Applicant _________________________________
APPLICATION FOR SCHOLARSHIP
The Agustin A. Ramirez, Jr. Family Foundation Scholarship Program
D. About your co-curricular and extra-curricular activities (i.e., not required as part of a course or academic
credit):
Please list the five co-curricular or extra-curricular activities which you feel were most important to you and
your development during your college years. Be sure to indicate any offices or special positions of
responsibility you held, or any recognition you received. The co-curricular and extra-curricular activities
may be in any area approved by your college, such as student government, debate and forensics, drama,
newspaper, yearbook, athletics (football, basketball, soccer, volleyball, baseball, etc.), art, music (band,
orchestra, choir, etc.), or other activities available to you and your classmates.
1.
2.
3.
4.
5.
E. About activities outside of school:
Please list below up to five programs, activities or events in which you have participated apart from those directly
related to your college program. These might include YMCA, YWCA, civic projects, church, synagogue or mosque
programs, clubs, community service groups, charitable activities, volunteering in hospitals or nursing homes, or
independent projects such as helping an elderly neighbor. Please describe briefly what you did and indicate any
offices or special responsibility you had as an individual if it was a group activity.
1.
2.
3.
4.
5.
3
New-Already in College
AGUSTIN A. RAMIREZ, JR. FAMILY FOUNDATION SCHOLARSHIP PROGRAM
Name of Applicant ______________________________
APPLICATION FOR SCHOLARSHIP
The Agustin A. Ramirez, Jr. Family Foundation Scholarship Program
F. Please write and attach an essay of 250 to 500 words on one of the following topics:
1) Who has been your most important role model? Why?
2) What has been your most significant accomplishment to date and how will it help you
succeed in the future?
3) What do you want to be doing in ten years? How will your advanced studies help you
accomplish your goals?
G. What do you like to read?
During the past year have you read a book not required for your school work which was of special interest to
you? If so, tell us what book and what you learned from it or enjoyed about it.
II. About Anything Else:
What would you like to tell the judges about yourself, your educational objectives, special achievements not
indicated earlier, special satisfactions or disappointments you have experienced, or plans you have for the
future?
4
New-Already in College
AGUSTIN A. RAMIREZ, JR. FAMILY FOUNDATION SCHOLARSHIP PROGRAM
SCHOLARSHIP RECOMMENDATION
The Agustin A. Ramirez, Jr. Family Foundation Scholarship Program
HUSCO International
P.O. Box 257
Waukesha, WI 53187-0257
Phone: (262) 513-4200
I. To the Applicant
Please complete this section, then give form to your Guidance Director, Counselor, Faculty Advisor or Dean.
Applicant’s Name ______________________________________________________________________
Last
First
Middle
Home Address ________________________________________________________________________
Street
________________________________________________________________________
City
State
Zip Code
Current Date _______________________
II. To the Guidance Director, Counselor, Faculty Advisor or Dean
To assist the judges with selecting recipients of the Agustin A. Ramirez, Jr. Family Foundation Scholarships, we request data we believe is
essential for an objective evaluation of the applicant. The information you give us will not be shared with the applicant and will be destroyed
after scholarship recipients have been selected.
We understand the enormous demands you face in filling requests for college admission and scholarship application forms. If the
information requested is included in a form more convenient for you to submit, please attach other form and return it with this request.
(If the applicant wishes, the Student Evaluation may be completed by a teacher of his/her choice.)
In any case, please include a certified copy of the applicant’s school record. Call (262) 513-4200 if you have any questions.
Please return this form to:
Scholarship Coordinator
Agustin A. Ramirez, Jr. Family Foundation Scholarship Program
HUSCO International
P.O. Box 257
Waukesha, WI 53187-0257
Applicant’s expected date of graduation ____________
Applicant stands ____ exactly
____ approximately
_____ in a class of _______.
How would you describe the curriculum pursued by this applicant?
____ Below Average
____ Average
____ Above Average
Eval – Page 1
New-Already in College
____ Very Demanding
(This is a 2-Page form)
AGUSTIN A. RAMIREZ, JR. FAMILY FOUNDATION SCHOLARSHIP PROGRAM
EVALUATION of STUDENT
No Basis
For Judgment
Below
Average
Average
Above
Average
Among the Best
I’ve Encountered
CREATIVENESS
Imagination; the ability to
analyze a problem on
his/her own.
INDUSTRY
Energy, initiative; works
to full capacity.
LEADERSHIP
The capacity to assume
responsibility, to organize
work and execute a project
with others.
HUMAN RELATIONS
Usefulness, tact,
sociability, cooperation.
DEPENDABILITY
Work done promptly;
engagements kept.
CHARACTER
Integrity, honesty,
good reputation, proper
moral perspective.
Please provide additional comments or information about the student that can help the Selection Committee in its
decision.
Please Print:
________________________________________________________ _________________
Name
Position
________________________________________________________ _________________
Name College/University
School Telephone
___________________________________________________________________________
Address
__________________________________________
City
_______________ ______________
State
Zip Code
______________________________________________ _____________________________
Signature
Date
Eval – Page 2
New-Already in College