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                                                                                                              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 _______________

                                                                                   

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