elks essay 2011-2012

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2 First-Place Awards o$60,000

2 Second-Place Awards o$40,000

2 Jack London Third-Place Awards o$20,0002 Fourth-Place Awards o$16,000

2 Fith-Place Awards o$12,000

4 Sixth-Place Awards o$10,000

4 Seventh-Place Awards o$8,000

482 Runners-Up Awards o$4,000

Totl o $2,296,000

Scholarship, Leadership and Financial Need500 awards or the 2012-13 through 2015-16 academic years

Application Deadline: December 2, 2011

Elks National Foundation, Inc.2750 N. Lakeview Avenue

Chicago, IL [email protected] www.elks.org/enf/schola

Application must be submitted to the Elks Lodge nearest your home.

Visitwww.elks.org/enf/FindALodge.cfmto nd the Lodge closest to you.

E l k s N a t i o n a l F o u n d a t i o nMost Valuable Student Scholarship

2012 Application

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U t d kt t u tt

u utt qud t.

(P t t d.)

Completed Application. Original,

typed or neatly printed, no pencil,

three-hole punched and placed in a

older.

Essay (signed and dated).

Ocial Transcript o Grades. Include

a list o seventh semester classes.

Seventh semester grades are not

required.

SAT and/or ACT scores taken beore

November 15, 2011.

Counselor Report in a sealedenvelope.

Copies o Exhibits. Optional.

Double-sided acceptable.

Take application to your local Lodge

on or beore D 2, 2011.

Start the application process early.Visit www.elks.org/en/fndalodge.cm tond the Elks Lodge nearest to where you

ive. Many Lodges are only open in the

evenings and on weekends, so be sure to

contact the Lodge or application drop-

of times.

Read the instructions.We include

them or your benet; knowing exactlywhat you need to do will make the

application process go aster and

easier. For answers to Frequently Asked

Questions, visit www.elks.org/en/

scholars/mvsaq.cm

Dont forget to make a copy.Allapplications become the property o

he B.P.O. Elks o the U.S.A. and the ElksNational Foundation and will not be

eturned to you.

Make life easier for the judges.When youre nished, do not staple

or use paperclips on any part o your

application. Do not use plastic sleeves

to protect the pages. Simply place it, asnstructed, in a older.

E l k s N a t i o n a l F o u n d a t i o n2012 Most Valuable Student Scholarship Application

Scholarship, Leadership and Financial Need

T i P s f o r c o m P l e T i n g yo U r a P P l i c aT i o n

The type o older you should use or your

application is pictured above.

Dont hesitate to ask questions.Iyou are unable to get a hold o someoneat the Lodge, visit www.elks.org/en/

scholars/statechairmen.cm to nd your

state scholarship representatives contact

inormation.

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Scholarship, Leadership and Financial N

i n s T r U c T i o n s & g U i D e l i n e sYou must use the ocial 2012 MVS application. It must be dated and signed by you and your parent(sor guardian. Typed applications are preerred; however, neatly printed applications are acceptable. Anelectronic version is available to download at www.elks.org/enf/scholars.

Applications and all supporting documents must be in English or English translations. We highlyrecommend making photocopies o your application and supporting documentation. All applicationbecome the property o the B.P.O. Elks o the U.S.A. and the Elks National Foundation and will not bereturned to you.

This application must be submitted to the Elks Lodge in closest proximity o your permanent U.S. addon or beore D 2, 2011. To nd your local Lodge, visit www.elks.org/enf/ndalodge.cfm.

DO NOT SEND APPLICATION TO THE ELKS NATIONAL FOUNDATION IN CHICAGOit will be disqualieautomatically.

I you are selected to be one o the 500 National Finalists, you will be required to submit a secondary

application online. ddt t d t qut akd Qut, vtwww.elks.org/enf/scholars/mvsfaq.cfm. I you are unable to nd the answer to your question here oonline, email [email protected] call 773/755-4732.

EL IGIBIL ITYAny high school senior who isa U.S. citizen is eligible. Maleand emale students competeseparately or identical awards.

COMPL ETED APPL ICATIONYour application must be in a

older with inside pockets andclasps. See the Application Tipspage or an example.

Everything, except items insealed envelopes, should bethree-hole punched and placedin the clasps o the older.

The completed older shouldinclude the application, essay,transcript, test scores, counselorreport and optional exhibits asapplicable.

EMPLOYMENTList jobs held September 1, 2008,through August 31, 2011. Listapproximate total hours worked,not average hours per week. Youwill receive zero points in thissection i you do not list yourhours as instructed.

COMMUN ITY S ERVICEList community serviceperormed September 1, 2008,through August 31, 2011. Listapproximate total hours served,not average hours per week. Youwill receive zero points in thissection i you do not list yourhours as instructed.

HONORS AND AWARDSThe ollowing is a list to assist incompletion o the Honors andAwards section. Include awardssuch as Eagle Scout; Gold Award;

Teen o the Year; Statewide orNational Conerences (ex: Boys/Girls State, HOBY); National MeritFinalist; AP Scholar; major athleticand/or academic award. This listis not exhaustive.

L EADERS HIP AN DEXTRACURRICUL ARACTIVITIESList your pp highschool leadership roles andextracurricular activities, thenumber o years involved,and the hours-per-weekcommitment. Complete thissection as instructed even i youplan to include an activity sheet.

ESSAYWrite an essay o no more thanwords. The essay must be typedated and signed. See page 3 essay.

EXHIBITS ( OPTION AL )Exhibits are optional supplem

material. Attach up to 10 pageo exhibits o achievement inscholarship, leadership, athletidramatics, community serviceother activities. Exhibits may bdouble-sided. For examples, vwww.elks.org/enf/scholars/mvscfm. We emphasize quality oexhibits over quantity. Activitysheets, resumes, essays, etc., anot considered exhibits.

PARENTAL FINANCIALINFORMATIONParent(s), complete the nancinormation section based on 2010 IRS 1040. Should the appbecome a National Finalist, a co the applicants 2012 StudenReport will be required.

I your parents are divorced orseparated, answer the questiothe parent you lived with the min the past 12 months.

f o r d d i t i o n l i n o r m t i o n n d n s w e r s t o f r e q u e n t l y a s k e d Q u e s t i o n s ,v i s i t www.elks .org/enf /scholars /mvsfaq.cfm .

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m o s T V a l Ua b l e s T U D e n T a wa r D s

pplications must advance through local, district and state competitions to reach the nationalompetition. A student can apply or, but cannot accept, more than one Elks National Foundationholarship or grant in any one academic year. Legacy Awards and Emergency Educational Grants aree other scholarships ofered by the ENF. For details and eligibility, visit www.elks.org/enf/scholars.

ational Finalists will be notied by email in late February 2012. To be eligible or a scholarship, Nationalnalists are required to submit a secondary application online, which will include an essay, counselorsrm, college plans, and scholarships/grants/aid/awards received to date. Finalists will also be requiredmail their Student Aid Report to the Elks National Foundation oce in Chicago. The secondary

pplication must be submitted by March 23, 2012.

ational winners will be notied in writing by the Chicago oce o the Elks National Foundation in April012. Many Lodges, districts and states award their own scholarships through the MVS program. TheNF is only responsible or administering the 500 national awards.

or complete details on ENF scholarship administration, visit www.elks.org/en/scholars/mvs.cm.

you lived with both parents an

qual number o days in the past2 months, count the parent whoovided you with the greatest

mount o support, nancial asell as material. Material supportcludes cars, clothing, medical

nd dental payments, etc. Iat parent has remarried, youust include the stepparentsormation.

the divorce or separationccurred within the past ve

ars and the custodial parent

as not remarried, you mustovide nancial inormationthe non-custodial parent. I

hereabouts o the non-custodialarent are unknown or the non-

stodial parent is unwillingcomply, please explain in aparate statement.

OUN S ELOR REPOR This report must be completedy your high school guidanceounselor or appropriate schoolcial. The report orm andhool prole (i available)

i n s T r U c T i o n s & g U i D e l i n e s ( c o n T. )

must be secured in a sealed

envelope and included withthe application. A school proleis a document describing theschools demographics andcourse oferings.

TRAN S CRIPT & S AT/ ACTS CORESInclude an ocial, current highschool transcript o studentgrades. Transcript may be aphotocopy o an original thatbears the signature o the proper

school authority. The transcriptmust include seventh semesterclasses. It does not need toinclude seventh semester grades.

Either the SAT or the ACT must betaken beore November 15, 2011.

Test scores must be includedin the application, but may bephotocopies or printed rom theSAT and/or ACT websites. The SATessay score will not be taken intoconsideration. It is not necessaryto send a separate sheet o testscores i they are included onyour transcript.

IN DEPEN DEN T S TUDEN TWe will not accept an applicant asan independent student, unlessthe student is or has been a wardo the Court. We require a copy oa Court Document or a Notarizedletter rom an appropriateCourt Agency (Social Services)certiying such status.

HOME S CHOOL IN GHome-schooled studentsare eligible to apply or thescholarship. However, all aspectso the application must be lledout completely. When possible,a third party should completethe Counselors Report or theapplicant.

For additional inormationvisit www.elks.org/en/scholars/mvs.cm andclick on Frequently AskedQuestions.

a p p t D d : D 2 , 2 0 1 1

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Name _______________________________________________________________________________________

Mailing Address ________________________________________________________________________________

City ____________________________________ State__________________________ Zip___________________

Email Address(required)____________________________________________________________________________________

Phone ( ______ ) ________________________________ Gender Male Female

Date o Birth _____________________________ Place o Birth ___________________________________________

Name and Location o High School ___________________________________________________________________



P e r s o n a l i n f o r m aT i o n

s i g n a T U r e s

Last First Middle Initial

City, State or CountryMonth Day Year

c i T i z e n s h i PAre you currently an American Citizen? Yes No I no, see below.

NOTE: (Legal permanent resident status does NOT qualiy. Applicant MUST be a citizen on the date the application is signed.)

I you were not born an American Citizen, but are a Naturalized American Citizen, give date, place (Ofce or Court where Naturalization occurred) andNaturalization Number.

Date__________________ Place ________________________________________________ Number _____________

I you were not born in the United States, but are a citizen by bir th, explain circumstances._____________________________________

Month Day Year Court or Oce and City and State

For Lodge Use Onlymut hv ld edt t b aptd Jud

The Scholarship Chairperson, Exalted Ruler or Secretary o the B.P.O. Elks Lodge in the jurisdiction in which the applicant resident must sign the Lodge endorsement, certiying that he/she has reviewed the application and veries that it conoto the requirements o the competition. Applications should not be endorsed i they do not conorm. Applicants must usElks National Foundations ocial 2012 application to be considered.

This application, with attached exhibits, has been reviewed, and it conorms with the rules and regulations set orth by thNational Foundation Board o Trustees.

Lodge Name:_____________________________________________________________________ No:___________State:______

Date: ___________________________ (signature) ___________________________________________________________

loDge Personnel, Do noT orwarD aPPlicaTions To The en chicago oice. They will be DisQUaliieSend to district or state ocials, unless instructed otherwise. I you have questions, contact your state scholarship chair.

Lodge Scholarship Chairperson, Exalted Ruler or Secretary

By signing this application, you agree, i asked, to provide inormation that will veriy the accuracy o your completed ormyou purposely give alse or misleading inormation, you will be disqualied rom this contest. You agree to the use o yourname and inormation contained within the application or advertising, promotional and publicity purposes without consor compensation.Date__________________________ Signed by______________________________________________________________

Date__________________________ Signed by______________________________________________________________

Date__________________________ Signed by______________________________________________________________

(studt)

(mt/stpt/gud)

(t/stpt/gud)

Tolentino Rem A

181 Lodestone Drive

Milledgeville Georgia 31061

[email protected]

478 387-5475

05 20 1994 Milledgeville, GA

Georgia Military College Prep/ Milledgeville, GA

10/11/11

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w o r k e x P e r i e n c et jobs you have held between spt 1, 2008, d auut 31, 2011. Start with the most recent and include work on a

mily arm or or a amily business, even i you were not paid. I necessary, attach a separate sheet structured identically to thisction. List approximate total hours worked, not average hours per week. yu v 0 pt t t u dt t u u tutd. Complete this section even i you plan to attach an activity sheet or resume.

ecifc Nature o Work Employer Approximate Dates o Employment Total Hours

___________________________ ________________________ __________________________ _____________

___________________________ ________________________ __________________________ _____________

___________________________ ________________________ __________________________ _____________

___________________________ ________________________ __________________________ _____________

___________________________ ________________________ __________________________ _____________

___________________________ ________________________ __________________________ _____________

___________________________ ________________________ __________________________ _____________

___________________________ ________________________ __________________________ _____________

___________________________ ________________________ __________________________ _____________

GRAND TOTAL HOURS WORKED = _____________

c o m m U n i T y s e r V i c et community service you perormed between spt 1, 2008, d auut 31, 2011, starting with the most recent. Icessary, attach a separate sheet structured identically to this section. List approximate total hours, not average hours per

eek. yu v 0 pt t t u d t t u u tutd. Complete this section even i youan to attach an activity sheet or resume.

ecifc Nature o Service Organization Approximate Dates o Service Total Hours

____________________________ __________________________ ________________________ ____________

____________________________ __________________________ ________________________ ____________

____________________________ __________________________ ________________________ ____________

____________________________ __________________________ ________________________ ____________

____________________________ __________________________ ________________________ ____________

____________________________ __________________________ ________________________ ____________

____________________________ __________________________ ________________________ ____________

____________________________ __________________________ ________________________ ____________

____________________________ __________________________ ________________________ ____________

____________________________ __________________________ ________________________ ____________

GRAND TOTAL HOURS OF SERVICE = _____________

a p p t D d : D 2 , 2 0 1 12

asketball Referee

acation Bible School Volunteer

ervice Projects

Upward Basketball

Sacred Heart Catholic Church

National Honor Society

12/10 - 2/11

2008-2011

2010

45

60

10

115

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l e a D e r s h i P a n D e x T r a c U r r i c U l a r a c T i V i T i e s

h o n o r s a n D a wa r D sList scholastic, extracurricular, and civic honors and awards received during grades 9 through 12. Select the year received,state the nature o award (i.e. Girl Scout Gold Award), and select the level o recognition. P d t vt

d, as we may not understand their meanings. Include a brie description o each award on a separate sheet o paperee to explain, in 25 words or less, the purpose o the award and why you received it. Complete this section even i you pattach an activity sheet or resume.

a p p t D d : D 2 , 2 0 1 1

9 10 11 12

1. ______________________________________________________

2. ______________________________________________________

3. ______________________________________________________

4. ______________________________________________________

5. ______________________________________________________

Grade Level Honor/Award Level o Recogniti

SchoolState/

Regional National

In

nat

e s s a yOn a separate sheet o paper, prepare a typed essay o no more than 500 words on the ollowing topic. The essay must bdated and signed. Failure to do so will result in 0 points in this section.

U t dp xtuu tvt u ptzd ptt t ud t pt t xp d u, t u tutd, t u d ut ud t fud u p t utu.

List your pp leadership roles and extracurricular activities, in the order o importance to you. State the name o theorganization, years involved, hours-per-week commitment, leadership role and responsibilities held in that role. Examplesinclude, but are not limited to, student government, publications, debate, orchestra/band, varsity athletics, church groupsperorming arts, service programs, etc. Complete this section even i you plan to attach an activity sheet or resume.

Activity Grade Level Hours/Week Weeks/Year Positions Held/Honors Received/Letters Earn

_________________________ __________ _________ _____________________________

_________________________ __________ _________ _____________________________

_________________________ __________ _________ _____________________________

_________________________ __________ _________ _____________________________

_________________________ __________ _________ _____________________________

_________________________ __________ _________ _____________________________

_________________________ __________ _________ _____________________________

_________________________ __________ _________ _____________________________

_________________________ __________ _________ _____________________________

_________________________ __________ _________ _____________________________

9 10 11 12

11Douglas MacArthur Leadership Award

YES

9 10 11GMEA State Piano Competition Honorable Mention

YES

11George Eastman Young Leaders Award

YES

11UGA Certificate of Merit

YES

11 Superior Cadet YES

JROTC

National Honor Society

Marching Band

Youth Leadership Baldwin

Varsity Basketball

National Piano Guild

Jazz Band

Sacred Heart LifeTeen

Mu Alpha Theta Honor Society

Spanish Honor Society

Yes yes yes yes

yes yes yes

yes yes yes yes

yes yes

yes yes

yes yes yes yes

yes yes yes yes

yes yes yes yes

yes yes

yes yes

5

110

1

10

2

2

1

1

1

26

2612

26

12

52

24

52

26

26

Battalion Commander (highest ran

Vice PresidentWoodwind Captain/Soloi

YLB Alumni

Team Member, Varsity Lett

National Winner, Commendation Awa

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Pa r e n T a l f i n a n c i a l i n f o r m a T i o n

Parent(s): Complete the nancial inormation section based on your 2010 IRS 1040. Should the applicant become a National Finalist, a copy o theapplicants 2012 Student Aid Report will be required. Visit www.fafsa.ed.govor more inormation.

parents are divorced or separated, answer the questions or the parent the applicant lived with the most in the past 12 months. I the applicant lived withboth parents an equal number o days in the past 12 months, count the parent who provided the greatest amount o support, nancial as well as material.Material support includes cars, clothing, medical and dental payments, etc. I that parent has remarried, the stepparents inormation must be included.

the divorce or separation occurred within the past ve years and the custodial parent has not remarried, provide nancial inormation o the non-ustodial parent. I whereabouts o the non-custodial parent are unknown or the non-custodial parent is unwilling to comply, please explain in a separatetatement.

Fathers Name_________________________________Age________ Occupation_________________________________

Stepathers Name ______________________________Age ________ Occupation_________________________________

Mothers Name________________________________Age_________Occupation_________________________________

Stepmothers Name_____________________________ Age ________ Occupation_________________________________

Custodial Parents marital status as o today (choose one):

Mother: Married Single Widowed Separated * Divorced* Remarried**

Father: Married Single Widowed Separated * Divorced* Remarried**

With whom does applicant make his or her permanent home? Mother Father Both Other ___________________

Date o divorce or separation ___________________* For details, see the instructions above.

**Include stepparents income in the appropriate section and read instructions concerning custodial parent.

A. Number o people in amily, not including parents, who will receive the majority o parental support between Sept. 1, 2012, and Aug. 31, 2013. Includedependent children and others, e.g. dependent grandparent, living in household who receive more than hal their support rom parents.__________

B. Name and age o dependents. _________________________________________________________________________

_____________________________________________________________________________________________

C. Number o dependent children, including applicant, as dened above, attending college during academic year 2012-2013 on at least a hal-time basis.

_____________

D. Based on line 37 o your 2010 IRS 1040, indicate the custodial parent(s) adjusted gross income. You will receive 0 points in this section i this inormations not completed. Round the adjusted gross income to the nearest $100.

$________________________________

you have extenuating fnancial circumstances, please explain in 200 words or less on an attached sheet opaper.

a p p t D d : D 2 , 2 0 1 1

Rossello Tolentino 43 RN Manager

Marliz Tolentino 43 Registered Nurse

3

Rem Tolentino -17, Christian Tolentino - 12, Ethan Tolentino -8

1

120,000

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appt: Fill out your name and give this page to your counselor or appropriate school ocial. This section can be comby your counselor beore you are nished with the application, but must be in a sealed envelope and signed across the se

studt n _______________________________________________________________________________________cu:This orm will be used to veriy the students academic status, so be sure to provide accurate inormation. Pleainclude a copy o your school prole i available, and answer all o the ollowing questions, even i the inormation is incluin the prole. A school prole is a document describing your schools demographics and course oferings. I your school hpolicy o not ranking students, provide inormation to help us identiy promising applicants. P u t t d vp, d t , d v t t tudt t ud t ppt u.T b.P.o. e t tu t t t tudt.

This applicants grade point average (A=4.0) ________________________________ (qud)

The highest GPA in the graduating class? ___________________________________(qud)

Is the GPA based on weighted grades? Yes No

Class rank: The applicant ranks________ in a class o ________.

How many students have this rank? _________________________________________________________

How many rank above? ___________ Is the rank based on weighted grades? Yes No

I exact rank is not available, indicate rank to the nearest 10th rom the top__________________________

Applicants t test scores (qud): acT ____________________/Date taken __________________

saT Critical Reading ____________ Math __________ /Date(s) taken________

Are honors courses available? Yes No Has the applicant taken honors courses? Yes No

I yes, in which subjects has the applicant taken honors courses? _______________________________________________

Are Advanced Placement courses available? Yes No Has the applicant taken Advanced Placement courses? Yes

I yes, in which subjects has the applicant taken Advanced Placement courses? ___________________________________

_____________________________________________________________________________________________________

Are International Baccalaureate courses available? Yes No Has the applicant taken IB courses? Yes No

I yes, in which subjects has the applicant taken IB courses? ___________________________________________________

_____________________________________________________________________________________________________

How would you describe this applicants academic program compared with that o other students applying or scholarsh

Below Average Average Above Average Rigorous Most Rigorous

Is there a community service requirement to graduate? Yes No I yes, how many hours? __________________

Has the applicant ever been suspended or dismissed rom your school? Yes No

I yes, please explain the circumstances. ___________________________________________________________________



c o U n s e lo r r e P o r T

Last First Middle Initial

P p t d c u r p t v p d t .

Name (please print): ___________________________________ Position __________________ School Phone ___________

School Email ___________________________________________ Length o time acquainted with applicant____________

Signature _________________________________________________________________ Date ______________________

elks essay 2011-2012

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