James Gabriel Family Foundation Apply Form – Fill Out and Use This PDF

James Gabriel Family Foundation

Scholarship Program for Associates and Their Families

2011 OFFICIAL APPLICATION FORM

ELIGIBILITY REQUIREMENTS AND INSTRUCTIONS FOR COMPLETION

Thank you for your interest in the James Gabriel Family Foundation Scholarship Program. We are pleased to present current Gabriel Brothers and Rugged Wearhouse associates and their families with the opportunity to further their education in any post-secondary educational program of their choice. In order to be eligible for the James Gabriel Scholarship, applicants must be either a current associate/employee of Gabriel Brothers or Rugged Wearhouse or an immediate family member of a current associate/employee of Gabriel Brothers or Rugged Wearhouse, AND meet ALL of the following eligibility and application requirements:

RApplicant must be accepted to or enrolled in any post-secondary (post high school) educational program (including trade school, college, art institute, etc.). Proof of acceptance or enrollment must be submitted with the completed Official Application Form.

RApplicant must timely submit a completed Official Application Form along with:

Ran official transcript from the institution in which the applicant is currently enrolled and/or attending,

AND

Ra personal essay not to exceed two hundred fifty (250) words describing how the applicant plans to use his/her education to impact the world in a positive way, including why he/she is the best candidate to receive the 2011 James Gabriel Scholarship. NOTE: The essay must include the total word count at the top of the essay submission.

RApplicant must ensure that a current letter of reference/recommendation from an academic contact (instructor, teacher, professor, etc.) is timely received by the JGFF Selection Committee.

Applicants are welcome to submit any additional information that they believe will be helpful/valuable to the Selection Committee.

Each page of the application packet must include the applicant’s name and the date of submission.

Applications may be submitted any time after June 1, 2011, but before the deadline of July 15, 2011. An application will not be considered complete unless all of the application materials, as discussed above, are received on or before the July 15, 2011, deadline.

Application materials can be submitted by U.S. Mail to James Gabriel Family Foundation, 55 Scott Avenue, Morgantown, WV 26508, Attention: Lori Paletta-Davis. Applicants may also submit applications by e-mail in care of jamesgabriel.familyfoundation@gabes.net.

Please note that all scholarships are awarded on an objective and non-discriminatory basis, taking all factors into consideration.

APPLICANT INFORMATION

LastName:__________________________________________________________	First Name: ________________________________________		MI: ___________
Street Address (including apartment #): ________________________________________________________________________________________________________
City:_________________________________________________________________	State: ______________________________________________		Zip: __________
Phone#: _____________________________________________________________	E-mail: ______________________________________________________________
BACKGROUND INFORMATION
Are you a current associate/employee of Gabriel Brothers or Rugged Wearhouse?		Q Yes	Q No

If “Yes”, please indicate the city/state location ___________________________________________ and your date of hire ______________________________

Are you related to a current associate/employees of Gabriel Brothers or Rugged Wearhouse?Q Yes Q No

If “Yes”, please name the associate/employee, the facility at which they are employed, and the nature of your relationship with this associate: ________________________________________________________________________________________________________________________________________

JGFF 2011 Scholarship Application: LPD 2011 5-24 Page 1 of 2

Applicant Name: _____________________________________________________________________________________Date Submitted: _____________________

EDUCATION

High School: Please indicate Name and Address of High School attended/attending: _________________________________________________________

___________________________________________________________________________________________________________________________________________________

Date Diploma (or equivalent such as a GED) received:	________________________________________________________________________
GPA: ___________________________ Class Rank: ___________________	Course Focus: _______________________________________________________

Honors and Awards: Please list and describe any honors and awards that you have received and what they have meant to you.

_______________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________

Post-secondary Education Plans and Program: Please tell us about your educational plans. Any post-secondary programs qualify, including vocational programs such as mechanics courses, culinary training, college, to name a few. You must be accepted into and/or enrolled in a program in order to be eligible for the James Gabriel Scholarship. You must submit your notice of acceptance and/or enrollment with your completed Official Application Form.

Nameof Institution: ____________________________________________________________________ Program: ___________________________________________

Mailing Address (city, state, zip code):

_____________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________

ContactPerson:_________________________________________________________________________ Telephone #: ______________________________________

Extracurricular Activities: Please list and discuss any of your extracurricular activities. Include how your involvement with these activities prepared you for your future. ____________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________

CERTIFICATION AND SIGNATURE

By signing below, I certify that the information submitted in connection with this application for the James Gabriel Family Foundation Scholarship is true and correct to the best of my knowledge and belief. I grant the James Gabriel Family Foundation and the Scholarship Selection Committee the authority to review and verify any information that I have provided in this application.

By signing, I acknowledge that the James Gabriel Family Foundation may use my name and/or likeness for public relations purposes.

__________________________________________________________________________________________________________	_________________________________
Applicant Name (Print and Sign)	Date

______________________________________________________________________________________________________________	__________________________________
Parent/Guardian Name (Print and Sign, only if the applicant is still in high school OR under age 18)	Date

JGFF 2011 Scholarship Application: LPD 2011 5-24 Page 2 of 2