Young Trailblazers Scholarship 2014 Application

STUDENT INFORMATION

First Name:
Middle Name:
Last Name:
Home Address:
Apartment No. :
City:
State:
ZIP Code:
Phone:
Cell Phone:
Are we permitted to leave a message at either of these numbers regarding our organizational name or purpose? (If not, we will contact you via email.)
Email Address:
U.S. Citizen/Permanent Resident:
If not U.S., country of birth:
Date of Birth:
Is English your first language?
If not, what is?
Do you self-identify as LGBT?
If yes, are you "out and open" to your community?
How did you hear about the Live Out Loud Scholarship Program?
What is your ethnicity?	Asian Black/African American Latino/a Caucasian (non-Hispanic) Other
If other, please specify:

HIGH SCHOOL INFORMATION

High School (do not abbreviate or use nickname)

Special Program, if any:
Street Address, City/State, ZIP Code:
Expected graduation date (Month, Year):
Contact Person/ Admissions Counselor:
Contact person's phone number:
Grade point average in the units used by your school:
Out of a possible:

PARENT/GUARDIAN:
Title:
First Name:
Last Name:
Relationship to student:
Occupation:
Highest Level of Education (check only one):
None Some grade school Grade school graduate Some high school High school graduate Some college Associate's degree (2-year college) Bachelor's degree Some graduate school Graduate degree
PARENT/GUARDIAN:
Title:
First Name:
Last Name:
Relationship to student:
Occupation:
Highest Level of Education (check only one):
None Some grade school Grade school graduate Some high school High school graduate Some college Associate's degree (2-year college) Bachelor's degree Some graduate school Graduate degree

The following information should be provided if known. If not, then the information should be provided upon awarding of the scholarship in order to facilitate the distribution of scholarship funds.

Anticipated college, university, or technical/vocational school:
Street Address, City/State, ZIP Code:
Admissions Counselor:
Phone number:

STUDENT CERTIFICATION

I certify that the information contained in this application is true.

Applicant's Signature:
Date:

1. Please describe your most important activities and achievements, including academic honors, community service, and other volunteer opportunities, extracurricular activities, and work experience.

2. Please explain your financial need. Are there any extenuating circumstances that will impact your ability to pay for school?

3. Please describe the challenges you have encountered in your home, school, or community because of your LGBT identity and/or your action as a LGBT leader. How have these challenges affected you? How have you chosen to face these difficulties?

4. Please indicate your intended academic major in college or tech/vocational school. Why are you choosing this particular area of study? If you are unsure, please describe what interests you plan to explore and why.

5. Please describe the activities in which you plan to participate during your college tenure (i.e., campus/community service, extracurricular activities, paid/unpaid work experience).

6. Please describe your career aspirations after you graduate from college or tech/vocational school.

LETTERS OF RECOMMENDATION

Students must submit two letters of recommendation that attest to their leadership, courage, and commitment to LGBT issues from academic and/or organization professionals (teachers, directors, advisors, etc). Please ask your recommenders to send letters directly to:

Live Out Loud
c/o Alex LaCasse
570 Seventh Avenue, 9th Floor
New York, NY 10018

ESSAY
In two essays of no more than 1,000 words each (typed and double spaced), please answer the following questions:
1. An integral part of Live Out Loud’s mission is to connect LGBTQ youth with role models. Who is your role model? Why? How have you been a role model in your school and/or community?
2. How have you distinguished yourself as a leader in, or on behalf of, the LGBT community? What leadership roles have you shown during your high school years? Describe a situation or project you have initiated. What were the results? What challenges did you come up against while executing this project? How has this project impacted your community?

Young Trailblazers Scholarship 2014 Application

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