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Leonard P. Roberts Memorial Scholarship Academic Year 2011-2012 Application

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Leonard P. Roberts Memorial Scholarship

Academic Year 2011-2012 Application

* Please type the application using a 12-point font.

General Information

Name Social Security Number

School Attending
Local/Temporary Address Phone
City State Zip Email___________________________________

Permanent/Parents Address Phone

City State Zip

Scholastic Achievement (30 Points): Enclose most recent transcript verifying GPA (and not just credits earned)
Grade Point Average in Major (20 Points): Cumulative GPA (10 Points):
Major:  Business Administration  Engineering Performing/Visual Arts  Other
Class Status as of Fall 2011  Junior  Senior (Must be entering junior or senior year at four-year Miami Valley institution)

Financial Information (25 Points for Financial Need)

Parents/guardians of applicant provide the following financial information:
Size of household during the current year

(include parents/guardians, applicant and

other dependents)
Annual income (2010)
Adjusted gross income (2010)
Applicant provide the following financial information:
Gross income earned during 2010
Savings, checking, investments, trust funds

Scholarships awarded for 2011-2012

If unknown for the coming year, please report

scholarships from the most recent academic year.

Grants or loans awarded for 2011-2012

If unknown for the coming year, please report

aid from the most recent academic year.

Describe any special financial circumstances:

Arts Involvement (20 Points)

Describe your current involvement in the arts. Include consumer activities (i.e. audience member at various events) as well as participatory activities (i.e. singing in choir, music lessons, dance lessons, creative writing, visual/fine arts classes, or other classes you are taking in college, etc.) If you need additional space, continue on a separate page or include in your essay.

Personal Essay (15 Points)

Please include no more than a typed, two-page, double-spaced essay in 12-point font stating your accomplishments (highlight activities, awards, community/campus involvement etc, that you are especially proud of) and goals for the upcoming year. You are also encouraged to write about why the arts are important to you and to the quality of life on your campus and in your community.

Letters of Recommendation (10 Points)

Please include two letters of recommendation: one of which must be from the department of your field of study.


Please double-check your documentation to ensure that you have remembered to include the following. Please include ONE original and FIVE copies (do not staple) , collated in order (for the benefit of the committee members):

 Copy of your Personal Essay (described above)

 Copy of your transcripts (must include your GPA, not just your credits earned)

 Copy of your financial aid application (FAFSA)- include the Student Aid Report (SAR) with Expected Family Contribution (EFC)

 Copy of financial aid award letter from your school (identifying other scholarships, loans, grants, and estimated family contribution)

 Copy of each letter of recommendation (described above)
We certify that information on this application is true to the best of our knowledge. We also authorize the release of information from the college Financial Aid Office and allow this information to be shared with the Roberts Scholarship Committee.

Applicant signature Parent/guardian signature

Date Date

Deadline for receipt of applications: 5:00 p.m. Monday, May 2, 2011.
Include the original and five copies of all application materials, collated into sets.

Mail or deliver to: Culture Works

126 North Main Street

Suite 210

Dayton, Ohio 45402

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