Cultural Crossroads, Inc.

The Cultural Crossroads scholarship ($500.00) is available to all senior high school students in Jackson County, Missouri, who are enrolled or about to be enrolled in a public institution of higher education (i.e., a state or county university or community college, but not a for-profit institution) in a degree or vocational program, and who demonstrate an awareness of cultural competency and a desire to promote peace and justice. The application form follows. Please fill it out completely and submit to Cultural Crossroads. Remember that there are no incorrect answers – we simply want to learn about you and your plans. We wish you good fortune, both with this application and with your future plans. Application deadline is February 1. Application may be submitted in several formats: For online form, click here: https://form.jotform.com/92106260789158 In the alternative, you may print the following form and submit it by email or mail to: o By email to CulturalCrossroads@hotmail.com o By mail to Cultural Crossroads, Inc. 3605 Blue Ridge Blvd Independence, MO 64052 NOTE: IF YOU EXPERIENCE ANY DIFFICULTIES WITH EITHER THE ONLINE FORM OR THE FORM BELOW, PLEASE CONTACT CulturalCrossroads@hotmail.com AND WE WILL EMAIL YOU AN APPLICATION FORM. (THE FORM IS BEST VIEWED ON CHROME.) APPLICATION FOR CULTURAL CROSSROADS SCHOLARSHIP A. PERSONAL INFORMATION Name: ___________________________________________________________________________ Address: ___________________________________________________________________________ ___________________________________________________________________________ Email address: ___________________________________________________________________________ Phone number: ___________________________________________________________________________ Age at last birthday: _____________ (DOB: MM/DD/YYYY): ____/____/________ High school: ___________________________________________________________________________ Higher education institution: ___________________________________________________________________________ ___________________________________________________________________________ I am enrolled for next fall. I am not enrolled yet, but will be by this date: ________________________ Degree or program of interest: __________________________________________________________________________ IF STUDENT IS UNDER THE AGE OF 18 YEARS: Parent/Guardian Name(s) _____________________________________________________________________ Parent/Guardian Contact number __________________________________ Parent/Guardian Email: _________________________________________________ HIGH SCHOOL INFORMATION (please attach copy of your “unofficial” transcript) Attendance record: if less than perfect, please tell us what issues you faced: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Grade point average: __________ Honors received in high school, if any: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Extra-curricular activities in high school, if any: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ COMMUNITY SERVICE/VOLUNTEERISM: Does your school offer community service opportunities? YES (answer next two questions) NO (skip next two questions) How many hours of service did you perform last year? ________________________ How many hours during previous years? ____________________________________ Have you volunteered with any nonprofit organizations? YES NO If so, which ones and for approximately how many hours? ___________________________________________________________________________ ___________________________________________________________________________ In addition to community service organizations, I have been involved in the following clubs, both affiliated with my high school and nonaffiliated, in my free time: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ SOCIAL QUESTIONS What do you think is the most important benefit from your high school years? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ What do you hope to achieve by enrolling in higher education (i.e., past high school)? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ What do you think is the greatest challenge facing our society at this time? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ How would you address that challenge? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ EXTRA CREDIT: In 200 words or less, describe your “ideal” society and how you believe you can make a difference in the world to realize that ideal. (Attach an extra sheet for this question.) If you choose to not include an “extra credit” essay, mark here _____ and simply sign and complete your application.) CONFIRMATION: By completing and submitting this application, I hereby I confirm that the information provided is true and correct, and I understand that including any knowingly false information automatically disqualifies me from eligibility. If I earn the scholarship for which I am submitting this application, I give permission for my name and photo to be used in publications.