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Patrick L. Newman Mic-O-Say Scholarship Application

Tribe of Mic-O-Say Patrick L. Newman Scholarship

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Tribe of Mic-O-Say Patrick L. Newman Scholarship
PURPOSE
The Newman Mic-O-Say Scholarship provides educational assistance to members of the Tribe of Mic-O-Say. This scholarship honors a man who spent a good part of his life involved with Boy Scouts. This program is only open to members of the Pony Express Council Tribe of Mic-O-Say and is not restricted by geographic location.
ESTABLISHING THE SCHOLARSHIP
Mosaic Life Care Foundation is a 501(c)(3) public charity dedicated to championing education and empowering people to build healthy and thriving communities.
DEADLINE
Oct. 15, 11:59 p.m.

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INFORMATION REQUIRED FOR THIS APPLICATION
1. Personal Information

2. Parent/Guardian Data

3. High School Data

5. Post-Secondary School Data

6. Scouting Experience

7. Work Experience

8. Activities, Awards and Honors

9. High School/Post-Secondary Transcript

10. Photo Suitable for Publication

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PERSONAL INFORMATION
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
County*
Date of birth*
Date Format: MM slash DD slash YYYY
Email*
Phone*

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PARENT/GUARDIAN DATA
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relationship to applicant:*
Phone*

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HIGH SCHOOL DATA
School Name*
Graduation Date:*
School Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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POST-SECONDARY SCHOOL DATA
Name of institution where you are currently enrolled or plan to attend:*
Include city, state, and whether it is a two year, four year, or graduate institution.
Name of institution where you are currently enrolled or plan to attend. If unknown, please list in order of preference the schools to which application for admission has been sent.
Degree and career field you plan to pursue:*
Anticipated graduation date:*

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SCOUTING EXPERIENCE
Are you currently registered in BSA?*
- Yes
- No
Unit type and number:*
Are you an Eagle Scout?*
- Yes
- No
Number of Palms:*
Mic-O-Say Rank:*
Tribal Name:*
Years at Geiger:*
Years at other council camps:*
Years on Geiger Staff:*
Staff Honors:*
Dance Coup (Color):*
Lone Bear Council:*
Warriors Council (years):*
Clan Chieftain (rank/year):*
Silver Coup (year):*
Tapper Coup (year):*
Philmont:*
National Jamboree:*
Make Talk Staff (years):*
List other scouting awards:*
List dance ribbons:*
List costume ribbons:*
List religious awards:*
List noteworthy leadership:*
List other high adventure activities:*

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WORK EXPERIENCE
Do you have employment experience?*
- Yes
- No
Employer:*
Date of employment:*
Date Format: MM slash DD slash YYYY
Approximate number of hours worked each week:*
Amounts earned each week:*
Add additional employment:*
- Yes
- No
Employer:*
Date of employment:*
Date Format: MM slash DD slash YYYY
Approximate number of hours worked each week:*
Amounts earned each week:*
Add a third employer:*
- Yes
- No
Employer:*
Date of employment:*
Date Format: MM slash DD slash YYYY
Approximate number of hours worked each week:*
Amounts earned each week:*

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ACTIVITIES, AWARDS, AND HONORS
List all school activities in which you have participated during the past four years (e.g., student government, music, sports, etc.). Include number of years:*
Indicate special awards, honors, and offices held:*
List all community activities in which you have participated without pay during the past four years (e.g., church work, volunteer work). Include number of years:*
List high school and college activities separately:*

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NARRATIVE INFORMATION
Please do not provide personally identifiable information.
What are your goals as they relate to your education and career objectives? Include the reasons for your choice of profession and post-secondary institution as well as your long-term goals after obtaining your degree or other certification.*
Why do you want to receive this scholarship?*
Please share any unusual or personal circumstances that have affected your achievement in school, work experience, or your participation in school and community activities.*
How have you applied one of your resolutions/scouting principles in your daily life? How do you intend to apply it in your future?*

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TRANSCRIPT INFORMATION
High school students and post-secondary students who have completed less than one full semester of post-secondary education at the time of submittal must include a high school transcript of grades that includes class rank:
Students currently enrolled in college or vocation-technical school must include their most recent college or technical school transcript:
UPLOADS
A photograph suitable for publication with this application.*
Will you be in attendace at the Conclave for the presentation ceremony?
- Yes
- No
Consent*
In submitting this application, I certify that the information provided is complete and accurate to the best of my knowledge.
Falsification of information may result in termination of any scholarship granted. This application becomes property of the Tribe of Mic-O-Say. I hereby authorize the Pony Express Council, BSA, the Tribe of Mic-O-Say, and the Patrick L. Newman Mic-O-Say Scholarship committee to use this photograph and name in related to press releases and/or other scholarship marketing publications.

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Championing education and empowering people.

Patrick L. Newman Mic-O-Say Scholarship Application

Tribe of Mic-O-Say Patrick L. Newman Scholarship

Step 1 of 11

Tribe of Mic-O-Say Patrick L. Newman Scholarship

PURPOSE

ESTABLISHING THE SCHOLARSHIP

DEADLINE

INFORMATION REQUIRED FOR THIS APPLICATION

PERSONAL INFORMATION

PARENT/GUARDIAN DATA

HIGH SCHOOL DATA

POST-SECONDARY SCHOOL DATA

SCOUTING EXPERIENCE

WORK EXPERIENCE

ACTIVITIES, AWARDS, AND HONORS

NARRATIVE INFORMATION

TRANSCRIPT INFORMATION

UPLOADS

Main office

Caregivers

Forms

Newsletter

Resources