Application Download Application The Cevonn L. Butler Entrepreneurial Spirit Scholarship
All questions must be answered fully and accurately. The information contained in this application will be kept confidential. Please submit the completed application to The Lionel and Cathlene Butler Foundation, 10026 Sagecourt Drive, Houston, Texas 77089, and request that the high school send an official transcript to the same.
APPLICANT PERSONAL INFORMATION
Name ________________________________________________ Marital Status _______________
Residential Address__________________________________________________________________________________ (No. and Street) (City) (State) (Zip Code)
Contact Information: Phone: ___________________ Email: _________________________________
Age ______ Date of Birth (Month, Date, Year) _____________ Place of Birth (City,State)_________________
HOUSEHOLD FINANCIAL INFORMATION
Parent(s) or (Guardian’s) Name(s): __________________________________________________________________
His/Her Employer ______________________________ Annual Household Income _____________
Do you live in the same household as your parent(s) or guardian named above ? Circle: Yes or No If your answer is no, please explain. ____________________________________________________________________________________________________________________________________________________________________________________
Total number of dependents claimed by your parent(s) or guardian on the last federal tax filing ? __________
Please show below the gender, ages and current grade levels (including college) of dependents claimed by your head of household in the last federal income tax filing.
GENDER AGE GRADE
__________ _____ ________
__________ _____ ________
__________ _____ ________
APPLICATION: (Continued, Page 2 of 4)
MY ENTREPRENEURIAL SPIRIT
What motivated you to apply for this scholarship? __________________________________________________________________________________________________________________________________________________________________________________________
Please indicate below any venture or employment you have held during high school or college that you believe demonstrates your entrepreneurial spirit. Please indicate whether this work or venture was during the evenings, the weekends, or during the summer.
Start (Mo./Yr) End Employer Type of Work
_________ _________ _______________________________ ______________________
_________ _________ _______________________________ ______________________
_________ _________ _______________________________ ______________________
Which one or more of the above do you believe can be identified as an entrepreneurial venture? ________________________________________________________________________________
What motivated you to get involved in this venture or ventures? ____________________________________________________________________________________________________________________________________________________________________________________
Where do you hope or plan for the experience gained from the above named venture(s) to lead you? __________________________________________________________________________________________
__________________________________________________________________________________________
What career do you plan to prepare for in college? ________________________________________
List at least two reasons why the Foundation should award you this scholarship? ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
HIGH SCHOOL EDUCATIONAL INFORMATION
Please have separately an official high school transcript or other document from your graduating high school submitted to the Foundation attesting to your satisfactory completion. This information should include your grade point average (GPA) and/or your class ranking. In addition, please include the following information on this application below:
Your GPA: (Ex., 2.5 out of 4) ______________ Class Ranking: Circle (Upper, Middle, Lower)
List below the three high school subjects you performed your best in. __________________________________________________________________________________________
APPLICATION: (Continued, Page 3 of 4)
OTHER ACTIVITIES - HIGH SCHOOL
Please list below the extracurricular school activities you have participated in such as band, athletics, drama, etc. Designate by each activity the grade in high school during which you participated. (For example: Band: all grades; Football: 11-12th grades)
____________________________________________________________________________________________________________________________________________________________________________________
Please list special honors and achievements you have received (societies, crafts, skills, etc.) __________________________________________________________________________________________
__________________________________________________________________________________________
Please list your favorite recreation and hobbies. ____________________________________________________________________________________________________________________________________________________________________________________
COLLEGE ADMISSIONS INFORMATION
Please list the first three colleges you have applied to and indicate the current status of the application, i.e., pending or approved.
First Choice __________________________________________________________________________
Second Choice __________________________________________________________________________
Third Choice __________________________________________________________________________
Please list any financial assistance you have applied for and indicate the current status, i.e., pending or approved (Examples of assistance: work/study, scholarships, grants, etc.)
Amount Type of Assistance Institution Applied To
_________ _____________________________ _____________________________
_________ _____________________________ _____________________________
_________ _____________________________ _____________________________
A Scholarship awarded by the Foundation will be a supplement to your college education. How do you plan to use these funds ?
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
APPLICATION: (Continued, Page 4 of 4)
REFERENCES
Please list the names, contact information, and addresses of three persons not related to you that the Foundation may contact as references, and ask these three references to write a letter of recommendation and forward to the Foundation. (This information may also be emailed).
Name Contact Information (Phone, email) Position / Job Title
_______________________ ____________________________________ _____________________
_______________________ ____________________________________ _____________________
_______________________ ____________________________________ _____________________
ADDITIONAL REMARKS: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I certify that to the best of my knowledge, all information contained in this application is true.
Signature ________________________________________________________ Date _______________