Langie Scholarship Application

Louis & Sally Langie Eagle Scout Scholarship Application

Seneca Waterways Council, Boy Scouts of America

Grants of $16,000.00 ($4,000.00 per year) (one-time grant, nonrenewable) are made available by the Louis and Sally Langie Eagle Scout Scholarship Fund.

Who can apply?

Any Eagle Scout who earned his Award in the Seneca Waterways Council, and meets the qualifications noted below. Applicants may have earned their Award at any time prior to their request. It is not limited to Scouts earning the Award in their senior year, but you must be a graduating senior to apply.

In order to qualify, you must:

1. Be currently registered with the Seneca Waterways Council, Boy Scouts of America.

2. Be a graduating high school senior and an entering college freshman in the year you are applying for the scholarship. Grants are awarded only to high school seniors graduating in the calendar year in which scholarships are presented.

3. Have an SAT score of at least 800 (combined 2 parts) and/or ACT score of 26. You must take the SAT or ACT in time to submit the results with the application.

4. Have demonstrated leadership ability in Scouting and a strong participation in extracurricular activities.

5. Possess a financial need.

6. Have the endorsement of a volunteer or professional Scout leader who knows you personally.

7. Application must be submitted by the May 1, 2017.

APPLICATION FOR GRANT (Please type or print in black ink)

Name    Social Security #

Home Address

City    State    Zip

Home Telephone    Date of High School Graduation

Date of Birth    Date of Eagle Scout Award

Full name of Parent/Guardian: Father    Mother
Guardian

Contact Phone Number for Parents:

SCHOOL ACTIVITIES

Name of high school/preparatory school

Address    City    State    Zip

Principal’s name    Telephone

Your anticipated ranking in class of students

SAT score – math* comprehension* written* and/or ACT composite score

*You must use score from the same test shown on your high school transcript.

List the activities you have been involved in during your time in high school:

OTHER ACTIVITIES

List your activities outside of school and Scouting, such as civic and religious activities:

COLLEGE PLANS

In order of preference, list colleges or schools to which you have applied or plan to apply.

College Name Estimated Cost Per Year

College Name Estimated Cost Per Year

College Name Estimated Cost Per Year

College Name Estimated Cost Per Year

What would you like to do when you graduate from college?

SCOUTING RECORD

I am currently registered in Troop No. Post No. Expiration date

Patrol Leader    50-Miler

Senior Patrol Leader    Historic Trails Award

Assistant Senior Patrol Leader    Hornaday Award

Junior Assistant Scoutmaster    BSA Lifeguard

Varsity Squad Leader    Religious Emblem

Varsity Team Captain    Sea Explorer Quartermaster

Varsity Co-Captain    OA Vigil Honor

Post President    Medal of Merit

Post Vice President    Heroism Award

Area Explorer Officer    Honor Medal

National Explorer Officer    Honor Medal with Palms

OA Member

OA Chapter Chief

OA Lodge Chief

OA Section Chief

OA National Chief

Local Camp Staff

National Camp Staff

Total merit badges earned Bronze Palm Gold Palm Silver Palm

List other Scouting positions/awards.

List outdoor experiences of 5 or more days and nights. Indicate whether you served in a staff position for each group below:

Order of the Arrow

Council Camp or Expeditions

Philmont, High-Adventure Bases, National or World Jamboree

FINANCIAL NEED

Attach to this application a clear statement of your financial need. This is important and should be much more than “College costs a lot of money” or “I want to help my parents.” This statement applies to what distinguishes your need from others and sets you apart. What is unique about your need? Discuss special family situations, e.g., a disability, one-parent family, ill health of parent, parent’s loss of a job, number of siblings, number of siblings in college the year you attend, etc. What is your father’s and/or mother’s occupation and what was your family’s gross income last year? If you do not receive this scholarship, how will you arrange to go to college?

Father/guardian Employer Position

Mother/guardian Employer Position

As reported on last year’s federal tax form: Federal adjusted gross income Family taxable income

Have you received or do your expect to receive other financial aid grants? If so, please list names and amounts:

$

$

List jobs you have held during the past 2 years:

Employer Months Employed Amount Earned

This year $

This year $

Last year $

Last year $

On your own, how much money have you saved to assist in your college education? $

I hereby authorize the Eagle Scout Scholarship selection committee to request and obtain any information it may deem necessary. On my honor as a Scout, all information and statements on this form are true and correct.

I have read the foregoing application and it has my approval.

ALL ENCLOSURES MUST BE SUBMITTED WITH THIS APPLICATION.

Be sure to enclose the following items. Each enclosure is to have on it the applicant’s name and Social Security number. No more than 8 pages (one-sided) may be attached to this application.

Transcript of high school grades covering six semesters

SAT or ACT test scores. This may be on a separate sheet or on the high school transcript. (Home school students need to provide a transcript equivalent)

A letter of recommendation from Scoutmaster or other BSA volunteer or professional official who knows the applicant personally. No other letters of recommendation are needed.

A statement by the applicant clearly stating why he believes he needs financial aid. Statement must be signed by applicant and countersigned by the parent.

Mail the application to: Eagle Scout Servicenter, 2320 Brighton-Henrietta TL Rd, Rochester, NY 14623

This application becomes the property of the selection committee and will not be returned to the applicant.

The selection committee will inform all applicants of their decision between July and August.

This information is confidential.