United States JCI Senate Foundation

Scholarship Application
Eligibility: Graduating high school seniors in the United States, where that state has an active JCI
Senate program (see www.usjcisenate.org [under scholarship tab] for a listing of eligible states).
You must be a U.S. citizen to apply for this scholarship.

This package contains information and directions for applying to the United States JCI Senate
Foundation Scholarship Program. Each year (April) $1,500 grants will be awarded to graduating high
school seniors in the United States, who plan to continue their education at accredited post-
secondary colleges, or universities within the United States. The number of grants awarded annually
will be at the discretion of the United States JCI Senate Foundation. The monies must be used for
educational expenses in the first year of full-time study. Checks awarded will be made out in the name
of the recipient and the educational institution of their choice.

Instructions for applying for the US JCI Senate Foundation Scholarship

Please read the following points carefully. Failure to comply will be cause for disqualification.
1. Submission preference will be in a Microsoft Word compatible format. Typed or neatly hand printed
(blue or black ink only) submission will also be accepted. DO NOT DUPLEX YOUR APPLICATION. USE ONLY
SINGLE SHEETS.
2. Included in this application package are all the necessary forms. Your application packet pages must
be submitted in order as listed below. Failure to comply will be cause for disqualification.
• Student Check List
• Wallet size photo taped to a sheet of blank paper – see #14
• Applicant Information
• High School Contacts
• College Information
• Parent or Guardian Information
• Financial Statement
• School & Community Involvement
• Personal Statement (300 to 500 words) – see #3
• College or University Acceptance Letter (if applicable)
• Supporting documentation of your choice (awards, certificates, articles, pictures, etc).
o Limit three (3) sheets
• Reference Letters – 3 – see #4
• Signature – see #6
• Transcripts (grades and state / national test scores) – see #5

3. Your personal statement is limited to 500 words. Any more than 500 words will not be judged.
4. Reference letters are limited to three (3) letters with a maximum length of one (1) page (one side only)
each.
5. Your school transcript should be the very last attachment to your application package. Any student with a
GPA of 3.75 and above will be considered for the grant. YOUR ACT / SAT NATIONAL TEST SCORES SHOULD
BE INCLUDED IF YOU HAVE THEM. Note: While the ACT / SAT scores are not mandatory – Extra judging
points will be awarded for the test scores.
6. Sign the bottom of the Personal Statement section.
7. Your name must be on the top right corner of each sheet in the package, along with a page number.
When using a MS-Word compatible editor, enter you name in the ‘Header’ section.
8. Each student must have an active, working email address listed. PLEASE PRINT.
9. All materials MUST be submitted under one cover. Materials sent in multiple mailings will NOT be
accepted.
10. Your application must be postmarked no later than January 19, 2024 to the State Scholarship
Chairman listed under your state.
11. NO electronic submissions will be accepted.

Form: Scholar-2023-2024
12. Do not include these first two pages of i nstructions in your reply.
13. Your application will be evaluated by persons outside of your area so do not use acronyms for items
such as clubs, programs, events, or awards where they are not national programs. Where the name of the
item is not self explanatory, include a description. Example: REACH or J. Doe Memorial Award, should
include a description such as: St. Thomas Methodist REACH program to feed the homeless, J. Doe Memorial
Award for Top Female Tennis player.
14. You must include a 2.0 X 3.0-inch head shot photograph for use in our National publications. This
photo should be taped to a white sheet of paper with your name and state on the page under the photo.
By signing the application, you agree that your name and photo may be used as part of the pu blic relations
of the US JCI Senate, the US JCI Senate Foundation and their affiliates suc h as the associated state
programs.
15.To submit your application package:
Refer to the website www.usjcisenate.org under the scholarship section. Locate the state where you live and
submit your application to the state chairman. The due date is postmarked January 19, 2024. If your state
is not listed, you are not eligible. Do not submit the application to any address on the web page except
those under the State Scholarship listing section (packages submitted to the wrong address will not be
forwarded).
16. No electronic submissions will be accepted.

Form: Scholar-2023-2024
 United States JCI Senate Foundation
Scholarship Application
1. Applicant Information
Applicant Name Date of Application

Applicant Home Address Applicant e-mail address

City State Zip Code Phone Number

Are you a U.S. Citizen (check one) Yes No

2. High School Information

Name of applicants High School Counselor Name

Address & City State Zip Code Phone Number

High School E-mail contact (name and position)

3. School Information
Name of College or University you plan to attend

Address City State Zip Code

Have you been accepted to this College or University

Yes (if yes, attach copy of acceptance letter) No

4. Parent or Guardian Information

Father’s Name Check here if father is deceased

Father’s Home Address Occupation

City State Zip Code Phone Number

Mother’s Name Check here if mother is deceased

Mother’s Home Address Occupation Ch

City State Zip Code Phone Number

Form: Scholar-2022-2023
Do you have a Step-Parent or Guardian other than your Parents: Yes No
If YES, provide the following information
Step Parent or Guardian Name

Home Address Occupation

City State Zip Code Phone Number

List in chronological order the names of your brothers, sisters or other persons dependent upon your parents for support
Name Age Relationship

5. Applicant’s Financial Statement Information

The financial contribution of the applicant toward their own education is an important consideration in awarding this scholarship.
The committee does not wish to penalize those students whose industry and careful planning have been a consideration in planning
college attendance. This budget is to assist the committee in your understanding of the financial costs of your education. The
budget should be based on your first year of education. Your budget does not have to balance.
Income
1. Savings to date 1.
2. Expected scholarship awards 2.
3. Expected contribution from parents 3.
4. Earnings from part-time work 4.
5. Money from other sources: 5.
Include gifts from friends, relatives
Education insurance, loans, etc.
Total Estimated Income

Expenses
1. Tuition and Incidental Fees 1.
2. Room and Board 2.
3. Books and Supplies 3.
4. Clothing 4.
5. Incidental Expenses (Travel, Recreation) 5.
Total Estimated Expenses

Explain any special personal family or financial situation you believe merits consideration:

Form: Scholar-2022-2023
6. School and Community Involvement
Explain your involvement in school and community activities. Include any organization offices, awards, events or projects and how
your involvement made an impact on each and how your involvement has helped you in determining your future education.

7. Employment
Using an outline format or spreadsheet list your job, names of employers (including family business or self-employment), job
duties, type of job (occasional, part-time, full-time, summer work, etc.) and pay you received, if any. Include how this job
assisted you in preparing for your future education.

Form: Scholar-2022-2023
8. Personal Statement
Complete a statement of 300 to 500 words maximum, indicating your chosen field of study. State your reasons for this choice and
how this scholarship will impact your future. Include pertinent experiences, activities and accomplishments. NOTE: Attach an
additional sheet behind this page with your statement.

Sections 9-11 shows the order to list your attached documents. Ensure to sign section 12
09. College or University Acceptance letter (if applicable)
10. Supporting documentation of your choice (maximum of three (3) documents)
11. Reference Letters
You may include three (3) letters of reference from educators, clergy, employers, and/or community leaders. At least one must be
from an educator. References should be attached to this application.
12. Signature

I certify that the facts contained in this scholarship application are true and correct. The United States JCI Senate
Foundation is hereby authorized to verify any information contained in this application. I understand that any falsification
of misrepresentation will result in disqualification.
Signature of applicant Date Signed

Email address:

13. Transcripts
A copy of your current high school transcript MUST be included. This MUST include class scores and should include state test
scores if you have them. If you are taking college classes, include those as well.

Staple all pages together in the upper left-hand corner.

Be sure you include all references and other attachments.
Each page of your application MUST list your name and list the page number in the upper
right-hand corner.
Remember to sign the application package (above)

Check the website: www.usjcisenate.org to find the state chairman where you submit your
application.

Form: Scholar-2022-2023