(Note: These pages were prepared with Netscape Browser; Internet Explorer may print differently).
General Rules:
1. Print this application form. Copy it as many
times as needed. Use copies of this form
ONLY. Do not add auxiliary pages. Be sure applicants submit
2 reference pages.
2. All forms must be typed.
3. A senior BETA member in good standing who is interested in attending one of the colleges or universities listed below is eligible to apply for the scholarship.
4. The State BETA Council Chairman will appoint a team to screen all applications that will be presented to the State BETA council. Three candidates (unless the Council feels that others should be considered) will be selected to be presented to the Council for first selection interviews.
5. The Missouri BETA Council will act as the board of review to interview the selected applicants and choose the scholarship recipient at the State Convention on Saturday (time and place to be announced Friday night).
6. The recipient and an adult representative from his/her club must be in attendance at the State Convention in March when the scholarship is awarded.
7. A SEPARATE APPLICATION FORM MUST BE COMPLETED FOR EACH COLLEGE OR UNIVERSITY TO WHICH THE STUDENT WISHES TO APPLY.
8. The Application must be sent certified mail. DO NOT MAIL TO THE UNIVERSITY.
Applications For: Applications For
Missouri
State
Southeast Missouri State
and/or
and/or
Truman
State
Three Rivers Community College
Send to:
Send to:
Mr. Derek Urhahn
Dr. Tim Hager
BETA Scholarship
BETA Scholarship
Leopold R-3 School District
Doniphan R-1 Elementary School
100 Main St.
603 Summit
Leopold, MO 63760-0069
Doniphan, MO 63935
9. APPLICATION FORMS MUST BE POSTMARKED BY
THE DEADLINE DATE OF JANUARY 29, 2010.
VALUE OF SCHOLARSHIPS OFFERED
These scholarships are provided to the Missouri Beta Club for the active senior students who meet all qualifications and are selected by the Missouri Beta Council. The following information is accurate and complete to the best of the knowledge of the members of the Missouri Beta Council. Any changes in the value of the scholarships will be at the discretion of each school who provides the scholarship.
Missouri State:
Full tuition with room and
board in specified campus housing. Renewable if maintain 3.5 GPA
with minimum of 30 hours cumulative per year.
Truman State:
Full time tuition
- exact value will be determined when 2009-2010 rates are set. The
award will be potentially renewable at that specified dollar value through
four years of undergraduate study at Truman if the recipient meets scholarship
renewal requirements, which will be provided in detail to the recipient.
Southeast Missouri State:
Full tuition up to 16 hours
per semester up to 32 hours per year. Room and board in specified campus
housing. Renewable for eight semesters. Must maintain 3.5 GPA
with a minimum of 30 hours cumulative per year.
Three Rivers Community College
Full tuition plus
rental books and fees. Must maintain a 2.5 GPA each semester and
complete at least 12 hours successfully. Renewable for 4 semesters
(fall and spring).
NOTE: All schools who offer scholarships will also offer other scholarships of similar value. Scholarships such as Board of Governors, Freshman Academic, and/or Freshman Achievement Scholarships cannot be duplicated with the Missouri BETA Scholarship.
(Scroll down to Section I of scholarship application form)
Missouri BETA Club
Scholarship Application Form
SECTION I Information to be supplied by the applicant. Please type.
TO WHICH COLLEGE OR UNIVERSITY ARE YOU MAKING APPLICATION?
_________________________________________________________________________
Name
__________Social Security No.________
(first)
(full middle name)
(last)
School Name:______________________________Location:_________________, Missouri
Full name of
Parent or Guardian:_________________________________________________________
Permanent Address
of Parent or Guardian:_______________________________________________________
(street, box, or route)
(town)
(state)
(zip)
The applicant must use the remaining space to write an explanation of
your future plans for your education, goals you have set for yourself.
SECTION II Information to be supplied by the applicant. Please type.
SCHOOL ACTIVITIES:
List activities in which you have participated during high school. Include
clubs, teams, musical groups, etc. Note major accomplishments in
each. Select no more than ten (10)
Year
9 / 10/ 11/ 12
Activity And
Accomplishments
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
LEADERSHIP POSITIONS:
List elected or appointed leadership positions held in school, community, or work activities. Only those positions in which you were directly responsible for directing or motivating others should be included. For example: elected student body, class or club officer; committee chairperson; team captain; newspaper editor; work area manager or community leader. Select no more than ten (10).
Year
9 / 10/ 11/ 12/
Leadership Position
Activity or Organization
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
SECTION III Information to be supplied by the applicant. Please type.
COMMUNITY ACTIVITIES:
List community activities in which you have participated and note any major accomplishments in each. These should be any activities outside of school in which you participated for the betterment of your community. For example: church groups, clubs sponsored outside the school, Boy or Girl Scouts, volunteer groups, or community art endeavors. Select no more than ten (10).
Year
9 / 10/ 11/ 12
Community Activity And
Major Accomplishments
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
WORK EXPERIENCE, RECOGNITION, AND AWARDS:
List below any job experiences, honors, or recognition that you have received which support your bid to be a leader. Select no more than ten (10).
Year
9 / 10/ 11/ 12 Job, Recognition, or Award
Group or Activity
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
__/__/__/__ ____________________________________________________________
.
SECTION IV Information to be supplied by the High School Principal or Counselor.
Student Name ________________________________________________________
(first)
(full middle name)
(last)
The above applicant is ranked _________based on the first seven semesters.
There are _____seniors in the class. The applicant will graduate ______________.
Indicate applicant's scores on one of the following college aptitude
test (use ACT if available).
______________________________________________________________________
Date
Tested
Raw Score
Percentile Rank
______________________________________________________________________
ACT
Sci.
Sci.
ACT
Eng Math Read Reas
Com Eng Math Read
Reas Com
ACT
____ ____ ____ ____ ____
____ ___ ____ ____
____
_______________________________________________________________________
_______________________________________________________________________
SAT
Verbal Math
Verbal Math
SAT
SAT
______ ______
______ ______
_______________________________________________________________________
Enclose a copy of the student's high school transcript reflecting seven semesters.
(Signed)___________________________________ (Title)_________________________
Name of school _____________________________________
School address _____________________________________
_____________________________________
_____________________________________
_____________________________________
Date ____/____/____
(THIS INFORMATION SHOULD BE ENCLOSED IN A SEPARATE SEALED ENVELOPE AND
MAILED WITH THE APPLICATION)
SECTION V TWO Reference pages must be
completed by teachers selected by applicant
Each teacher should place completed reference in sealed envelope and mail
with the application.
Name of Student_________________________________________
Name of School__________________________ Teacher
Signature__________________
Instructions: Circle the number value in each CATEGORY
which most closely describes the student.
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INDUSTRIOUSNESS - Willingness to work, work habits, zeal, perseverance.
Lazy, little or
Seldom
Ordinarily
Occasionally does
Does extra work
no effort.
completes work. completes
work. extra work .
gladly.
0
1
2 3
4
5 6
7
8 9
10
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THOROUGHNESS - Accuracy, carefulness, exactness
Careless. Work is
Express ideas Work generally
Careful work.
Very careful and
always incomplete. carelessly.
complete & accurate Accurate.
thorough.
0
1
2 3
4
5 6
7
8 9
10
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INITIATIVE - Intellectual curiosity, willingness
to attempt new ideas, asks questions, shows interest.
Never tries
Seldom originates Sometimes
Often initiates
Marked ability to
anything new.
any work.
attempts new ideas. undertakings.
think independently
0
1
2 3
4
5 6
7
8 9
10
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RELIABILITY - Dependability, good judgment, honesty,
ability to get along without supervision
Dishonest. Neglects Often needs
Sometimes reliable.
Usually assumes
Thoroughly
obligations.
supervision. Needs prompting.
obligations.
dependable.
0
1
2 3
4
5 6
7
8 9
10
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COOPERATION - Ability to get along with others,
adaptable, tactful, agreeable, cheerful.
Disagreeable.
Slow to respond. Tends
to be
Does well in team
Always willing
Neglects obligations. Not willing to help.
agreeable & willing work. Agreeable.
to help others.
0
1
2 3
4
5 6
7 8
9 10
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EMOTIONAL STABILITY - Poise, ability to handle stress.
Unable to control
Occasionally loses Fairly well
balanced. Well balanced
Exceptionally
emotions.
self control.
Good control.
Poised
well poised.
0
1
2 3
4
5 6
7
8 9
10
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INTELLECTUAL CAPABILITY - Intelligence, natural
ability to succeed in academic effort.
Very slow to learn.
Needs to make extra Average
Quick to grasp
Gifted.
Lowest one/fifth.
effort to keep up.
intelligence.
subject.
Highest one/fifth.
0
1
2 3
4
5 6
7
8 9
10
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RECOMMENDATION - Based on the ratings on this form, this applicant
is:
Not recommended.
Recommended
Recommended
Recommended
Very highly
with reservations.
with confidence.
recommended.
0
1
2 3
4
5 6
7
8 9
10