Imperial Polk County Chapter

Military Officers Association of America

General James A. Van Fleet Scholarship Application

One $1,000 ($500 per year) Scholarship

 ELIGIBILITY

The applicant must be:

1. a high school senior graduating in the spring of 2017,

2. an active member of a Junior Reserve Officers Training (JROTC) unit in a Polk County, Florida high school,

APPLICANT

The applicant must:

1. plan on attending Polk County Community College beginning in the summer or fall of 2017 and carrying an academic workload of at least 9 credit hours per semester,

2. upon entering Polk Community College, agree to enroll in the 2- year basic course of the Florida Southern College Reserve Officers Training (ROTC) unit beginning in the fall of 2017;

a. while at Polk Community College, maintain the minimum class grade point average to qualify for the 2nd year award of $500 in 2017

3. be recommended by his/her JROTC Senior Military Instructor (SMI),

4. obtain the approval of his/her high school principal;

5. possess at least a “B” average in overall academic work from his/her high school;

6. have demonstrated leadership potential through school and community activities.

APPLICATIONS

Applications:

1. will be forwarded to every Polk County JROTC Senior Military Instructor by April 1, 2017,

2. must be returned to the Imperial Polk County MOAA chapter by April 21, 2017,

3. will be limited to one nomination per JROTC unit.

APPLICATION OF REQUIRED FACTS

For the 2014 – 2015 Academic Year

Important: Applications must be completed and returned on or before April 21, 2017. Applications should be mailed to:

Imperial Polk County Chapter

Military Officers Association of America

P.O. Box 3911

Lakeland, FL 33802

Name:____________________________________________

Social Security # _____________

Address:

_____________________________

_____________________________

Phone:_________________

High School________________________

Date will graduate________________

I certify that the information contained in this application is accurate to the best of my knowledge.

If awarded this scholarship I understand that the award is contingent upon me:

  • attending Polk County Community College in 2017 as a student carrying at least 9 credit hours per semester to receive the first $500 of the scholarship;
  • attending Polk County Community College in 2017 as a student carrying at least 9 credit hours per semester to receive the second $500 of the scholarship
  • enrolling in the Florida Southern College basic Reserve Officers Training Course for the 2017 (for the first $500 award) and 2017 (for the second $500 award).

Date:____________________, ________________________

Signature of Applicant

JROTC Senior Military Instructor Endorsement

The JROTC SMI is asked to certify that he recommends the applicant for the scholarship.

I have reviewed this applicant’s qualifications and recommend _____________ for the 2017 General James A. Van Fleet scholarship.

Date______________ SMI _____________Senior High School

High School Principal’s Endorsement

The high school principal is asked to sign the endorsement, certifying that the application is accurate as it pertains to the applicant’s high school academic achievements and school leadership activities.

This application, with attached exhibits, has been reviewed by me, and to the best of my knowledge and belief, accurately sets forth the high school record of ________________.

Date:__________________ _________________________________

Principal ____________Senior High School

Academic Record

Year Grade Point Average as of Last Reporting Period:____________________

Academic Honors and Awards

(State nature of honor or award and year) (Use additional pages as necessary)

a. Award: __________________________________ Year:__________

b. Award: __________________________________ Year:__________

c. Award: __________________________________ Year:__________

d. Award: __________________________________ Year___________

School Related Leadership Activities

e.g. student council

(State name of organization, position and year (Use additional pages as necessary)

a.Organization:_____________________Position:__________Year:_______

b. Organization:___________________ Position: __________Year:_______

c. Organization:___________________ Position: __________Year:_______

d. Organization: __________________ Position: __________Year: _______

School Related Extra Curricular Activities

e.g. band, athletics

(State name of organization, position and year (Use additional pages as necessary)

a. Organization:__________________ Position: __________ Year:______

b. Organization:__________________ Position: __________ Year:______

c. Organization: __________________ Position: ___________Year:_____

d. Organization: __________________ Position: ___________Year:_____

Community Related Civic Activities

e.g. charity fund raising

(State name of organization, position and year (Use additional pages as necessary)

a. Activity:______________________________ Year:__________

b. Activity:______________________________ Year:__________

c. Activity: ______________________________ Year: __________

d. Activity: ______________________________ Year: __________

JROTC Leadership Positions

(State position and year (Use additional pages as necessary)

a. Position: ________________________ Year:__________

b. Position: ________________________ Year:__________

c. Position: ________________________ Year:__________

d. Position: ________________________ Year: __________

JROTC Honors and Awards

(State award and year (Use additional pages as necessary)

a. Award: __________________________ Year:__________

b. Award: __________________________ Year:__________

c. Award: __________________________ Year:__________

d. Award:___________________________ Year:__________

Applicant’s Statement

State in the space provided below your answers to the following questions:

  • What has your participation in JROTC taught you about leadership?
  • How have you used these lessons in leadership in your school and community?
__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

_____________________________

Applicant’s Signature

Contact Us Today!

Imperial Polk County Chapter of MOAA
PO Box 3911
Lakeland, FL 33802


Phone: 863 602-0921

E-mail: gary_clark44@hotmail.com

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