johnathan c. fulcher crimestoppers...
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Jacksonville/Onslow County
Johnathan C. Fulcher
Crimestoppers Scholarship Application Form
Selection of Crimestoppers Scholarship is based on a number of factors,
with special emphasis on each individual’s character, community involvement,
leadership abilities and merit. Merit is demonstrated in a variety of ways:
leadership in school, civic and other extracurricular activities; academic
achievement and motivation to serve and succeed in all endeavors.
The Postmark Deadline for Applications is April 30th, 2014.
Finalists will be notified during the month of May.
A student may apply for a Crimestopper Scholarship Award if he/she is:
Graduating Senior in an Onslow County or a DOD school in Onslow County.
Residing in Onslow County.
Must be planning on attending a 2 or 4 year college.
Planning to pursue a major in the Criminal Justice or related field.
Students who have already received this scholarship are not eligible to receive
it again. It is a one-time scholarship.
Children of the Crimestoppers Board of Directors are not eligible.
Students who have received a full scholarship are not eligible.
A. Applicant Name: ___________________________________________
Mailing Address: ___________________________________________
Telephone Number: _________________________________________
College Course of Study: _____________________________________
Intended College Attending: __________________________________
Important: Review this form and make certain you have responded
accurately to all items.
I certify that all the statements made in this application form are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. Signature __________________________ Date _______________
High School Name _______________________________________
B. Counselor/Principal
Name of Contact Person __________________________
Phone (____)___________
Mail to:
Crimestoppers P.O. Box 436
Jacksonville, NC 28540
Eligibility
Requirements
Must submit:
1 official transcript 3 reference forms Completed application
Completed essay
Information/
Certification
Selection
Criteria
Deadline
Date
Academic Information NOTE: Equivalent scores for three common grading systems are given. If your school uses a different system, ask
your school counselor which oval to mark. Your application cannot be accurately evaluated if you omit this item. If “A”
is the highest grade in your school, consider it as choice 5 and adjust the other grades accordingly.
1. Fill in the oval that indicates your OFFICIAL cumulative grade-point
average on an unweighted basis at end of 1st Semester Senior year Indicate the type of
4-Point Scale Letter Grade Percent Grade curriculum for the courses
1 3.00-3.24 B 83-86 you are currently taking.
2 3.25-3.49 B+ 87-89 (Select only one)
3 3.50-3.74 A- 90-92 IB/AP/Honors
4 3.75-3.89 A 93-96 College preparatory
5 3.90-4.00 A+ 97-100 General/core studies
Vocational/Career
2. Please list any school related activities that you have been involved in during your high school career. List any
offices held and the academic year that you were involved in each activity. (i.e. National Honor Society, FBLA,
etc.)
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___________________________________________________________ 3. Please list any job experiences you have had during your high school career and indicate the dates worked
on the job. (Burger King, Food Lion, etc.)
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Additional Volunteer/Community Service Activities
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“Why have you chosen to pursue a degree in the Criminal Justice or related
field?” (300-500 Words)
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Reference Form Applicant’s Name: ________________________________________________________
As it appears on your Last First Middle Social Security Card
I am an applicant for a Crimestoppers Scholarship and have given your name as a reference. Your prompt attention
to the completion of this form will be greatly appreciated. This response is confidential. I hereby waive my right
of access to this reference:
________________________________________ _________________________
Applicant’s Signature Date
How long have you known the applicant? ( ) Years ( ) Months
What is your relationship to the applicant?
Check each item below in the space provided.
Qualities Below
Avg Avg
Above
Avg Outstanding Not Observed Comments
Character
Initiative/Resourcefulness
Dependability
Judgment
Honesty
Knowledge
Loyalty
Oral Communication Skills
Written Communication Skills
Organizational Skills
Interpersonal Skills
Overall Recommendation
Additional Comments:
_______________________________________________________________________
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Please return to the applicant with
the signature of the person completing
the reference written across the
sealed flap of the envelope.
Signature
___________________________________
Name (Please Print)
___________________________________
Address
___________________________________
Phone Number Date
Reference Form Applicant’s Name: _________________________________________________________
As it appears on your Last First Middle Social Security Card
I am an applicant for a Crimestoppers Scholarship and have given your name as a reference. Your prompt attention
to the completion of this form will be greatly appreciated. This response is confidential. I hereby waive my right
of access to this reference:
________________________________________ _________________________
Applicant’s Signature Date
How long have you known the applicant? ( ) Years ( ) Months
What is your relationship to the applicant?
Check each item below in the space provided.
Qualities Below
Avg Avg
Above
Avg Outstanding Not Observed Comments
Character
Initiative/Resourcefulness
Dependability
Judgment
Honesty
Knowledge
Loyalty
Oral Communication Skills
Written Communication Skills
Organizational Skills
Interpersonal Skills
Overall Recommendation
Additional Comments:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Please return to the applicant with
the signature of the person completing
the reference written across the
sealed flap of the envelope.
Signature
___________________________________
Name (Please Print)
___________________________________
Address
___________________________________
Phone Number Date
Reference Form Applicant’s Name: _________________________________________________________
As it appears on your Last First Middle Social Security Card
I am an applicant for a Crimestoppers Scholarship and have given your name as a reference. Your prompt attention
to the completion of this form will be greatly appreciated. This response is confidential. I hereby waive my right
of access to this reference:
________________________________________ _________________________
Applicant’s Signature Date
How long have you known the applicant? ( ) Years ( ) Months
What is your relationship to the applicant?
Check each item below in the space provided.
Qualities Below
Avg Avg
Above
Avg Outstanding Not Observed Comments
Character
Initiative/Resourcefulness
Dependability
Judgment
Honesty
Knowledge
Loyalty
Oral Communication Skills
Written Communication Skills
Organizational Skills
Interpersonal Skills
Overall Recommendation
Additional Comments:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Please return to the applicant with
the signature of the person completing
the reference written across the
sealed flap of the envelope.
Signature
___________________________________
Name (Please Print)
___________________________________
Address
___________________________________
Phone Number Date