2014 Application

APPLICATIONS MUST BE RECEIVED NO LATER THAN

NOVEMBER 7, 2014
Background:
The Palmer Scholars Foundation was founded in 1983 by R. Merle Palmer, a man with an extraordinary
vision for the youth of Pierce County. Merle Palmer was committed to seeing that all students were able
to attend and graduate from college regardless of their race, ethnicity or socioeconomic status. He
started the Palmer Scholars Foundation with this goal in mind. Palmer Scholars has provided
scholarships and caring mentors to over 450 students, and we look forward to welcoming our 32nd
cohort of scholars.
Eligibility:
To be eligible for this scholarship you must:

Live in Pierce County

Have a cumulative GPA of 2.0 or above at time of application

Identify as a member of a racial/ethnic minority group (e.g. African American, Asian,

Hispanic, Native American or Pacific Islander)

Have a desire to attend college or post high school training.

Demonstrate financial need (e.g. eligible for free or reduced price lunch, have an
Expected Family Contribution less than $4,800 according to the fafsa4caster/FAFSA, or
submit an explanation of why you believe you have significant financial need in the
event that your family income exceeds this amounts);

Graduate from high school or receive your GED no later than August 2015 or be
enrolled as an undergraduate student at an accredited college or university.

Participate in a personal interview with the Selection Committee if selected as a semifinalist. Selected students will be notified as to the date, time and location by the end of
December.

Selected students are required to participate in a series of workshops to prepare you for
your transition to college.

Note:
We require our students to:

Apply to a variety of colleges public, private, in-state, community and/or technical colleges

Apply for additional scholarships and financial aid.

Please submit your completed application along with the additional required documents to the Palmer
Scholars office electronically by November 7, 2014.

Palmer Scholars | PO Box 7119 | Tacoma, WA 98417

info@palmerscholars.org | 253-572-9008
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APPLICATION INSTRUCTIONS

Use the current year application only (2014)

Type or word process your essays (12pt. font, 1 in. margins, single spaced)

Limit each essay response to

Assemble your application packet containing ALL of the following attachments

Required Attachments:

Most recent copy of your high school or college transcripts

(Unofficial transcripts are acceptable.)

Copy of your completed fafsa4caster available at www.fafsa4caster.gov (US citizenship is not

required to complete a fafsa4caster).

Essays (3)

Essay #1: Introduction to your college roommate (please also include your future aspirations).

Essay #2: Overcoming/learning from adversities and challenges.

Essay #3: What education means to you and why is it important.

Letters of Recommendation (2)

First letter of recommendation

Second letter of recommendation

Please Note:

Application must be filled out in its entirety. Missing information could disqualify you
from consideration.

All information (transcripts, reference letters, essays, etc.) must be included or your
application packet will be considered incomplete.

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PART ONE: STUDENT INFORMATION

Section A: Student Overview
1. Name:
(First)

2. Gender:

Male

(Middle)

Female

(Last)

3. Race/Ethnicity:

4. Address:
(Street Number)

(City)

(Zip)

5. Date of Birth:

6. Home Phone:

Cell Phone:

7. E-Mail:

8. Current (or last attended) High School:

9. Cumulative GPA:
10. Intended College Major and Minor: ___________________ and _________________
11. Expected Family Contribution (EFC) as determined by the Fafsa4caster (citizenship is
not required to complete a fafsa4caster):

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Academic:
Senior Year Schedule: List the classes you are currently taking and the classes you plan to take in your
final semester of high school.
1st Semester Senior/Current Year

2nd Semester Senior/Current Year

Standardized Test Information: Indicate date(s) taken and scores below

SAT:
Date Taken/To be
Taken

Critical Reading

Math

Writing

English

Math

Writing

ACT:
Date Taken/To be
Taken

HSPE: Satisfied (or on track to satisfy) State Requirements?

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Yes

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No

Section C: College Information

1. Below list the colleges and universities you intend to apply to. We encourage you to apply
to several schools both in state and out of state, and both public and private.
College Name (Minimum of 2 instate required)

Date
Submitted

Date Intend
to Submit

Accepted

Denied/
Waitlisted

Public
Public
Public
Private
Private
Private
C.C.
Tech

Section D: Academic Activities, Non-academic Activities, Awards

12th

11th

Role

10th

Activity - Awards

9th

Please describe your academic and non-academic activities, internships and any awards received while a
student in high school. Academic activities include such things as membership in honor society,
MESA, peer tutoring, etc. Non-academic activities include participation in school sports, clubs, music,
jobs and volunteer experience. Indicate leadership activities such as being an officer in a school club
or serving as an ASB officer or representative. Finally, indicate any academic and non-academic
awards you received. If necessary, add an additional page to list additional activities and/or awards.

Hours/
Week

Section F: Family Responsibilities

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Weeks/
Year

Many students have extensive family responsibilities. Please describe what responsibilities you
have/have had that would be considered out of the ordinary. If not out of the ordinary, then what role in
the family did you enjoy most? What responsibility(ies) would you like to have had?

Section G: Status:
1. Legal Status:

Yes

U. S. Citizen:

No

Yes

Legal Resident:

No

2. Dependent Status:
a. Are you a parent?

Yes

No

Yes

b. Are you in foster care?

No

Yes

c. Are you an unaccompanied minor?

No

(as designated by the FAFSA)

3. Do you have a disability?
If yes, do you have an IEP?
If yes, do you have a 504 plan?

Yes

No

Yes

No

Yes

No

Briefly describe your disability and any accommodation you may have had in high school/thus far in
college:

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PART TWO: PARENT, FINANCIAL AID, AND SCHOLARSHIP

INFORMATION
Section A: Parent or Guardian Information
Mother (If applicable)
Name:
(First)

(Middle)

(Last)

(Street Number)

(City)

(Day)

(Evening)

(Occupation)

(Estimated Annual Income for 2014)

Address:
(Zip)

Phone:

Employment:

Father (If applicable)

Name:
(First)

(Middle)

(Last)

(Street Number)

(City)

(Day)

(Evening)

(Occupation)

(Estimated Annual Income for 2014)

Address:
(Zip)

Phone:

Employment:

Guardian 1 (If applicable)

Name:
(First)

(Middle)

(Last)

(Street Number)

(City)

(Day)

(Evening)

(Occupation)

(Estimated Annual Income for 2014)

Address:
(Zip)

Phone:

Employment:

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Section B: Financial Aid Information

1. Who do you live with?

Mother

Father

Guardian 1

Guardian 2

Self

2. Number of dependents claimed by you, your parent(s) or guardian(s):

3. Total number of people living in your household:
4. Are you or either parent/guardian receiving social security, disability benefits, food stamps, or
subsidized housing??

Yes

No

5. Any other family members attending college?

Yes

No

If yes, who, where and what year in college?

Name

College/University

6. Where do you plan to live while attending college?

Campus

Year in School

Home

Own Apt.

7. Have you applied for the Act Six Scholarship?

Yes

No

8. Are you a College Bound Scholar?

Yes

No

9. Optional Statement: Attach a statement explaining changes or unusual circumstances regarding

family, health, financial obligations, why you are returning to school after an extended absence or
employment status if not explained in your Fafsa4caster.

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Section C: Scholarship Information

List additional scholarships you have or intend to apply for. You are expected to apply for additional
scholarships by the time your interview takes place.
Scholarship Name

One year only

Renewable

Estimated Amount

I, the undersigned, certify that to the best of my knowledge all of the information on this form is correct. I
understand that the information submitted here and in my Palmer Scholars file may be discussed with the Palmer
staff, and with the Financial Aid Office at the college(s)/university(ies) to which I may be applying or attending.
In addition, if I am selected as a Palmer Scholar I agree to allow the Palmer Scholars staff and
college(s)/university(ies) I may be applying to or attending to use relevant information related to my enrollment,
financial aid, academic progress, contact information, and/or graduation information.
I, the undersigned, consent to allow Palmer Scholars to use my photograph(s), name and story and/or voice for
communication purposes, including but not limited to, printed and online publications, the Palmer Scholars
website(s) and Palmer Scholars social media page(s)/site(s). I also hereby release, defend, indemnify and hold
Palmer Scholars harmless from and against any liability arising from or related to said use. In addition, I, the
undersigned, voluntarily consent to Palmer Scholars' release of certain personal information to Palmer Scholars
mentors. I also hereby release, defend, indemnify and hold Palmer Scholars harmless from and against any
liability arising from or related to a use consistent with said release.

Name (printed)
Signature

Date:
Application and all accompanying documents are due electronically
By November 7, 2014

SHOULD YOU HAVE QUESTIONS ABOUT THE APPLICATION PROCESS, CALL THE
PALMER SCHOLARS FOUNDATION OFFICE at 253.572.9008

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PART THREE: ESSAY QUESTIONS

Instructions for essay questions:
Please type or word-process your responses. Your answers to each question should be approximately
150-400 words in length no more than one page per essay (12pt font, 1 in. margins, single spaced).
Please use a separate sheet of paper for each response and include the essay question in bold at the top of
each page.
1.

Write a letter introducing yourself to your college roommate. Describe yourself to this person so
that he or she has a well-rounded sense of who you are and who you hope to become before the
two of you meet on campus.

2.

Evaluate a significant experience, risk you have taken or ethical dilemma you have faced & its
impact on you.
Or
What was the most difficult time/period of time in your life? How did you persevere? How did
your perspective on life change as a result of this experience?

3.

What does a college education mean to you?

PART FOUR: LETTERS OF RECOMMENTATION

Letters of Recommendation: Please include two (2) letters of recommendation, one of which must be
from a teacher and the second may be from a school staff person, an employer, civic or religious leader.
References may NOT be from a relative. You may use copies of letters you already have.

PART FIVE: TRANSCRIPT

Transcript: Please include a copy of your most recent transcript (unofficial transcripts are okay)
through your last full school year. If you are invited for an interview, then you will need to provide an
additional copy with grades through the first half of your current academic year.

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