HESI COLLEGE SCHOLARSHIP APPLICATION

February 14, 2017

The Hispanic Student Society International (HESI) Scholarship Program provides monetary awards to graduating High School students who will be attending any college in the fall of each year. The total amount each student is eligible for is up to $1,000 to be split evenly between Fall and Spring semesters. Scholarships will be awarded at the start of each semester provided the student has maintained an overall 3.0 GPA or better. Scholarship awards require a minimum of 12 hours at registrars office can only be used for tuition and fees. All applicants will receive a “Hispanic Leadership Award” however the scholarships awards are selected by the board and only to winners selected. Since 2009, HESI has provided 37 scholarships and $37,000 to Seniors from the Humble Independent School District.

RULES AND INSTRUCTIONS

Eligibility and Qualifications:

To be eligible, a student must be graduating from a Humble ISD High School and will attend any accredited college, university, or approved post-secondary institution in the Fall of 2017.

To qualify for consideration, the applicant must:- currently, be a senior- be at least 50% Hispanic or Latino using their natural born parents.- demonstrate financial need- present a record of academic success- declare intent to fulfill the post-secondary school’s certificate or degree requirements

Scholarship recipients must adhere to the following while attending a post-secondary institution:- maintain a grade point average (or equivalent) of 3.0 GPA or better- take a minimum of 12 credit hours each semester, or be a full-time student- take relevant courses toward their degree or certificate- be in good standing with the school- send a letter stating their OFFICIAL GPA INFORMATION to the HESI Scholarship Chairman below at the end of the Fall

Semester to the HESI address below

Application packages for the HSSI Scholarship Program must include the following:1. A completed application form (typed or printed in black inK) including an essay.2. A current resume3. A current official high school transcript4. A letter of recommendation from either a teacher or counselor

                 LEADERSHIP & SCHOLARSHIP APPLICATION

PERSONAL INFORMATION

_______________________ ___________________________ _____________________________________________________STUDENT’S NAME ADDRESS CITY/STATE HOME TELEPHONE

STUDENT ID# ___________ STUDENT SOCIAL SECURITY# _________EMAIL_______________________________________

ALTERNATE PHONE___________YOUR PERSONAL EMAIL _____________YOUR PERSONAL CELL # __________________

___________________________ _________________________________________________________________________FATHER’S NAME OCCUPATION & PLACE OF EMPLOYMENT

HIGHEST LEVEL OF EDUCATION (High School, college, graduate school, etc.): __________________________________________

MOTHER’S NAME OCCUPATION & PLACE OF EMPLOYMENT

ALTERNATE PHONE________________________________ALTERNATE EMAIL _________________________________________

HIGHEST LEVEL OF EDUCATION (High school, college, graduate school, etc.) ___________________________________________

_____________________________ NUMBER OF CHILDREN IN THE FAMILY ________________________________________GUARDIAN (IF DIFFERENT)

LIST THE SCHOOL ACTIVITIES IN WHICH YOU PARTICIPATED, LIST THE CHURCH AND COMMUNITY ACTIVITIES, and LIST NAY SIGNIFICANT JOBS (You may attach a separate resume of the following)

LIST THE SCHOOL ACTIVITIES IN WHICH YOU PARTICIPATED

School Organization or Activity Name Accomplishments and Offices HeldGrade

9 10 11 12

LIST THE CHURCH AND COMMUNITY ACTIVITIES IN WHICH YOU PARTICIPATED IN

Organization or Activity Name Accomplishments and Offices HeldGrade

9 10 11 12

II.           FINANCIAL INFORMATION

WILL YOU BE ABLE TO ATTEND COLLEGE WITHOUT FINANCIAL AID?

YES___ NO___

HOW DO YOU PLAN TO FINANCE COLLEGE (parents, loans, scholarships, etc.)?

__________________________________________________________________________________________________

__________________________________________________________________________________________________

PLEASE PROVIDE NAMES AND AGES OF ALL PEOPLE LIVING IN YOUR HOUSEHOLD?

__________________________________________________________________________________________________

__________________________________________________________________________________________________

IF YOU DO NOT LIVE WITH BOTH OF YOUR PARENTS, WILL THE PARENT WITH WHOM YOU DO NOT LIVE WITH CONTRIBUTE TO YOUR COLLEGE EDUCATION?______ I live with both of my parents.______ Yes, both parents will be contributing to my college education.______ No, both parents will not be contributing to my college education.______ Neither parent will be contributing to my college education.

MARK BELOW THE MOST ACCURATE COMBINED ANNUAL INCOME RANGE OF YOUR HOUSEHOLD, INCLUDING CONTRIBUTIONS BY NON-RESIDENT PARENT”

□ $0-$14,000 □ $15,000-$29,999 □ $30,000-$44,999 □ $45,000-$59,999

□ $60,000-$74,999 □ $75,000-$89,999 □ $90,000-$104,999 □ $105,000-$119,999

□ $120,000 or more

PLEASE IDENTIFY ANYONE IN YOUR HOUSEHOLD WHO IS ATTENDING COLLEGE AND STATE WHERE WILL HE/SHE BE ATTENDING?

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

  DESCRIBE ANY SPECIAL CICUMSTANCES THAT MAY AFFECT YOUR ABILITY TO PAY FOR COLLEGE:

___________________________________________________________________________________________________________

__________________________________________________________________________________________________________

LIST ANY SIGNIFICANT JOBS YOU HAVE HELD Employer Position/Duties Years Hrs/WK

LIST ANY SPECIAL HONORS OR RECOGNITION RECEIVED:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

LIST THE COLLEGES YOU PLAN TO ATTEND:

1ST CHOICE - _______________________________________________________________________________________

2ND CHOICE - _______________________________________________________________________________________

3RD CHOICE - _______________________________________________________________________________________

  ACADEMIC RECORD

WHAT IS YOUR HIGH SCHOOL GRADE POINT AVERAGE? (ON A 100-POINT SCALE)

WHAT CLASSES ARE YOU TAKING THIS YEAR? ______________________________________________________

WHICH, IF ANY, OF THESE CLASSES ARE DUAL CREDIT? _______________________________________________

WHAT WILL BE YOUR COLLEGE MAJOR OR FIELD OF STUDY (If decided)?

III.          PERSONAL REFERENCES

a. IDENTIFY TWO TEACHERS OR ADMINISTATORS WHO KNOW YOUR WORK:

NAME ___________________________________________TELEPHONE______________________________

SUBJECTS TAUGHT _______________________________________________________________________________________

NAME _____________________________________ TELEPHONE__________________________________

SUBJECT TAUGHT _________________________________________________________________________

b. LIST ONE UNRELATED CHARACTER REFERENCE WHO KNOWS YOU AND YOUR FAMILY (NEIGHBOR, CLERGY, ETC.):

NAME _________________________________________________________________

_______________________________________________________________________ADDRESS TELEPHONE

IV.         LETTER OF RECOMMENDATION

You are required to provide a letter of recommendation from either one of the teachers identified above or a counselor familiar with your circumstances. Which teacher or counselor will provide your recommendation?

Name and Lenth of relationship?

V.           ESSAY THAT YOU WROTE FOR THIS APPLICATION

ON A SEPARATE SHEET OF PAPER, SUBMIT A TYPED PARAGRAPH ABOUT ONE OF THE FOLLOWING TOPICS:

□ Chose a person or situation that impacted your life and described what it meant to you. □ Choose an issue of importance to you and explain the significance of that issue to yourself, family, community or

your generation.□ Your Career Goals and what has influenced you to enter this career choice and where you intend on it taking you.

VI.         SIGNATURES

I accept the rules and regulations of this application and understand the decision of the scholarship committee is final.  The information I have provided on this application is correct and I hereby

consent to the release of a copy of the above-named student’s transcript, GPA, class rank, and test scores.

_______________________________________ _____________________________________________Student Signature Date

_______________________________________ _____________________________________________Parent/Guardian Signature Date

Student’s application mailed package must be postmarked or received by May 5th. 2017

RETURN THE COMPLETED APPLICATION TO:Joe C. RamirezHispanic Executive Society InternationalAttn: Scholarship Application2607 Ridge Pine Kingwood, Texas 77345

CONTACT HESI IN THE EVENT OF ANY CHANGE RECEIVED AFTER THE ORIGINAL APPLICATE RECEIPT DATE. HESI RESERVES THE RIGHT TO ALTER OR WITHDRAW FINANCIAL ASSISTANCE. APPLICATIONS AND ALL INFORMATION

SUBMITTED WITH THE APPLICATION BECOME THE PROPERTY OF HISPANIC EXECUTIVE SOCIETY INTERNATIONAL. ALL SUBMISSIONS WILL BE KEPT CONFIDENTIAL, EXCEPT FOR REVIEW BY SCHOLARSHIP COMMITTEES.