Gate of Opportunity Application Form

This application is designed to help us learn about your experiences in the context of how you would contribute to and benefit from the Gate of Opportunity Scholarship Program. If you have not already done so, we encourage you to familiarize yourself with the scholarship program details on our Website before completing the form.

Complete this application as it best applies to you and your experiences during your high school years. While we welcome student résumés or activity summaries you may already have prepared, we do ask that you complete this application form even if you are submitting such items. Leave blank any fields in Sections 2, 3 and 4 that do not apply to your experiences.

SECTION ONE - PERSONAL INFORMATION

NAME

First:   Middle:   Last:    

Preferred Name (if different from first):

CONTACT INFO

Street/P.O. Box:

City:   State: (Select) Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming   Zip Code:            

Cell Phone/Primary Contact Number:

Email Address:  

HIGH SCHOOL

Name:

City:   State: (Select) Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming  

INTENDED MAJORS(S) (If known at this time)

Major Option #1:

Major Option #2:

CAREER/POST COLLEGE PLANS (If known at this time)

Career/Post College Option #1:

Career/Post College Option #2:

SECTION TWO - WORK EXPERIENCE (Paid jobs)

This section should include any paid work experience(s) throughout your high school career. Examples include restaurant server, office assistant, child care provider, lawn maintenance, etc. For each work experience, please list the following: employer/company name, job title/position description, number of months or years employed, approximate hours worked during a typical school week and key job functions.

SECTION THREE - EXTRACURRICULAR ACTIVITIES

Please list up to 5 extracurricular activities that have been the most meaningful to you during your high school years. These could include clubs, sports, fine arts, honor societies, student government, etc. For each activity, please list the following: type of activity/description, number of months or years involved, any leadership positions held and any awards/significant achievements.

SECTION FOUR - OTHER COMMITMENTS

Please list up to 3 other commitments or involvements that have been the most meaningful to you during your high school years. These could include scouts, religious activities, volunteer activities, etc. For each please list the following: type of activity/description, number of months or years involved, any leadership positions held and any awards/significant achievements.

SECTION FIVE - SHORT ANSWER (Answer each in 150 words or less)

Describe three positive skills you have cultivated during your high school years.

Describe three skills you hope to cultivate further during your college years.

Recognizing that any student would benefit from the Gate of Opportunity Scholarship, describe how you especially would benefit from the scholarship if selected.

APPLICATION AGREEMENT

I understand that in order to be considered for the Gate of Opportunity Scholarship I must be offered fall 2013 freshman admission to Berry College by the Office of Admissions and that Berry must receive my official 2013-2014 Free Application for Federal Student Aid (FAFSA) results by Friday, February 22, 2013 at 5:00pm Eastern. I understand that it typically takes 1-2 business weeks for Berry College to receive official FAFSA results once I have completed it.

Agree