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I ndia Association of Kanas City (IAKC) Academic Achi evement Award

Application FormAward Date: November 16, 2013

Venue : Blue Valley North West High SchoolOverland Park, KS

PURPOSE:

India Association of Kansas City will award at least One and up to Two AcademicAwardstoqualified students of Indian origin living in the Kansas City metropolitan area. The total awardamount will be a maximum of $500. The overall purpose of the award is to recognize thestudents exemplary academic standing, and extracurricular accomplishments, as well as torecognize the students clear philanthropic goals. The application will be reviewed by a panel ofjudges for academic, extracurricular achievements, community activities, ingenuity and quality.

The winners will be notified by email.

CRITERIA:

1. Applicant must be a Kansas City metro area resident, and his/her parent(s) must be amember of IAKC for the year 2013-2014.2. Applicant must be a High School student in the year of the award.3. Applicant must demonstrate high academic standing.4. Applicant must show clear academic goals with an interest in philanthropy.5. Applicant must exhibit community service and extra-curricular activities.6. Applicant should NOT have ever received/awarded ANY academic or related

recognition from IAKC.7. Ask an administrator or teacher, print, complete, scan and e-mail the completedrecommendation form toacademic@iakc.org.Deadline is November 4, 2013.

Please read this form carefully and answer each question completely. Your application will notbe processed if all of the questions are not answered in full and/or the package is incomplete.Mark N/A for items not applicable. Your application should be submitted via e-mail only.

Deadline for submission of entire package is NO LATER THAN Midnight November 4th,

2013.

APPLI CATION PROCESS:

1. Print and complete the form below. Scan the form and e-mail the completed form toacademic@iakc.org.

2. Ensure that the letter of recommendation has been completed, scanned and sent via e-mail toacademic@iakc.org.

3. Copy of current school transcript/report card has been scanned and electronicallyincluded with the submission of this application form.

mailto:academic@iakc.orgmailto:academic@iakc.orgmailto:academic@iakc.orgmailto:academic@iakc.orgmailto:academic@iakc.orgmailto:academic@iakc.orgmailto:academic@iakc.orgmailto:academic@iakc.orgmailto:academic@iakc.orgmailto:academic@iakc.orgmailto:academic@iakc.org

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PERSONAL INFORMATION:

First Name: _________________________ Middle Name: _________________________Last Name: _____________________________

Street Address:____________________________________________________________________________________________________________________________________________________________City: ___________________________________________ Zip Code: ___________________Email Address:____________________________________________________________________________________________________________________________________________________________Telephone:(_____)________________

Check the Grade you are currently in :

High SchoolFreshman Sophomore Junior Senior

Name of school currently attending:____________________________________________________________________________________________________________________________________________________________

School Address:_____________________________________________________________________________________________________

School City: ______________________________________State:____ Zip Code: ___________

Graduation Year: _____________________ Grade Point Average: ________

What is your cumulative Grade Point Average? ______________________

Class rank ( If applicable)? __________________

If available, highest ACT or SAT score____________________________

Where do you plan to attend college?________________________________________________________

Have you currently applied for admission? _________________Been accepted? _____________

Proposed major? _______________________________________________________________

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PARENT AND GUARDIAN I NFORMATION:

Full Name and Address of Parents or Guardians:

Fathers Name:____________________________________

__________________________________________________________________________________E-mail:___________________________________Phone: Home (____)_________________; Cell (_____)___________________

Mothers Name: _____________________________________________________________________________________________________________________E-mail:___________________________________Phone: Home (____)________________; Cell (_____)___________________

SCHOOL ADM INISTRATOR/TEACHER INFORMATION:

Name _____________________________________________________

School/School District _________________________________________

Email _______________________________________________________

Telephone No.________________________________________________

ACTIVITIES/ORGANIZATIONS:

Please list activities/organizations in school and outside of school. Indicate offices held andaccomplishments while in office.

1. __________________________________________________Year ________Accomplishments:

2. _____________________________________________________Year ________Accomplishments:

3. _____________________________________________________Year ________Accomplishments:

4. _____________________________________________________ Year ________ACADEM IC HONOR/AWARDS:

Please list.

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1. ____________________________________________________Year Awarded________2. ____________________________________________________Year Awarded________3.

____________________________________________________Year Awarded________

4. ____________________________________________________Year Awarded________ACHIEVEMENTS IN EXTRA-CURRICULAR ACTIVITI ES:

Please list.

1. _______________________________________________ Year Awarded _________2. _______________________________________________ Year Awarded _________3. ________________________________________________Year Awarded _________4. ________________________________________________Year Awarded _________

COMMUNITY SERVICE ACTIVITI ES:

Please list.

1. _____________________________________________________Year ________2. _____________________________________________________Year ________3. _____________________________________________________Year ________4. _____________________________________________________Year ________

STATEMENTS OF PURPOSE:

1. Write a statement detailing why you deserve this award. If applicable, indicate any financialadversity that your family has recently faced. Your response should not exceed 50 words.(Use additional paper)

2. Provide a more detailed response to this segment of essay writing. Imagine yourself as aneducator, business executive, community leader, or other decision-maker charged withimproving the quality of life of the people across the world in your particular futurechosen profession/subject major. Write a statement outlining your academic goals,reasons for selecting these goals, and the direction you will take to improve the humancondition through your chosen subject/major.

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The length of your response should not exceed 200 words. (Use additional paper).

I certify that this information is correct and that the essays submitted are my own work.Signed: ________________________________________________________

Date: ___________*For questions regarding this scholarship application, contact Dr. Hira Nair at hira_nair@yahoo.com(Chair IAKC Academic ScholarshipCommittee)

mailto:hira_nair@yahoo.commailto:hira_nair@yahoo.commailto:hira_nair@yahoo.commailto:hira_nair@yahoo.com