AL NEUHARTH FREE SPIRIT SCHOLARSHIP AND JOURNALISM CONFERENCE PROGRAM

2009/2010 APPLICATION FORM
To qualify for this program:
  1. You must be a high school senior graduating in the spring/summer semester of 2010.
  2. You must be committed to pursuing a career in journalism.
  3. You must demonstrate qualities of a "free spirit."
To apply, you must follow these steps:
  1. TYPE the required information in the boxes below.
  2. SUBMIT electronically for our applicants' database.
  3. PRINT OUT the completed application form
  4. MAIL this completed application form (signed by you, your parent/guardian and school official) with all the necessary documents and materials including two essays, sealed letter of recommendation, high school transcript, samples of your jounalistic work and a 4x6 headshot photo. Application must be POSTMARKED NO LATER THAN OCTOBER 15, 2009.
All submitted information will remain confidential.
For more information about this program visit www.freedomforum.org/freespirit

BIOGRAPHICAL INFORMATION
First Name
Middle Name
Last Name
Preferred Name
Birth Date
(mm/dd/year)
Gender
Home Address
City
State
Zip
Home Phone
(111-111-1111)
E-mail
 
Ethnic Background (Optional)
Other (specify)
 

PARENT OR GUARDIAN INFORMATION
Mother's Name
Mother's Work Phone (111-111-1111)
Father's Name
Father's Work Phone (111-111-1111)
Guardian's Name
Guardian's Work Phone (111-111-1111)
 

FREE SPIRIT

Below are some characteristics that have been identified as qualities of a free spirit. Please check any that apply to you.
 

ACADEMIC INFORMATION

The following questions pertain to your academic background. If your school does not have a GPA system, please estimate your current GPA on a 4.0 scale.
Type of School
Grade Point Average
SAT/ACT Score (if applicable)
School Name
# of Senior Students in Class
School Address
City
State
Zip
School Phone (111-111-1111)
School Fax Number (111-111-1111)
Principal's Name
Principal's E-mail
Guidance Counselor's Name
Guidance Counselor's E-mail
School Web Site
Journalism Advisor's Name
Journalism Advisor's E-mail
School Newspaper Name
School Newspaper Web Site (if applicable)
Month/Year of Graduation (must be in 2010)
  /2010
 
College/University You Plan to Attend
(List your top three in order of priority -- do not abbreviate university names)
1.
2.
3.
 
What type of media organization would you like to work for after you graduate college?
Others (please specify)
  
 

ACTIVITIES/COMMUNITY SERVICE/AWARDS
 
Top Three Extracurricular Activities (400-character max)
1.
2.
3.
 
Top Three Community Service or Volunteer Activities (400-character max)
1.
2.
3.
 
List of Awards or Honors Received in High School (400-character max)
1.
2.
3.
  

PROGRAM SURVEY
How did you learn about this program?
Other
 

IN THE NEXT PART OF THE APPLICATION, THE FOLLOWING MATERIALS AND DOCUMENTS MUST BE PRODUCED AND MAILED WITH THE PRINTED APPLICATION.

  1. ESSAYS
    Both essays must be typed (or hand-printed), double-spaced and signed/dated by BOTH the applicant and the school advisor, principal, teacher or counselor.

    Essay One:  Write an essay explaining why you want to pursue a career in journalism. (Maximum of 500 words)

    Essay Two:  Write an essay about your specific qualities as a free spirit and explain your experiences and/or struggles that make you a free spirit.  (Maximum of 500 words)
 
  1. TRANSCRIPT
    An official transcript must be submitted with this application.
 
  1. LETTER OF RECOMMENDATION
    The principal, counselor or teacher must write a letter of recommendation that describes why this student is nominated for the Al Neuharth Free Spirit Scholarship and Conference Program.  Describe the applicant's personal qualities, his/her commitment to pursuing a career in journalism and characteristics that make him/her a free spirit.  Person recommending must be familiar with the applicant's work and personal charactersitics.  The letter should be placed in a sealed envelope and submitted with this application.
 
  1. JOURNALISTIC WORK 
    Applicant must submit at least one published or broadcast sample of his/her work related to journalism.  Multiple samples of work are acceptable.  Work may include any of the following (work samples will not be returned):
    • Byline printed article or online clipping (published format)
    • DVD - must have label with applicant's name, state and brief description of the broadcast with date. 
    • Videotape - must have label with applicant's name, state and brief description of the broadcast with date.
    • Audiotape - must have label with applicant's name, state and brief description of the broadcast with date.
    • Byline photo
    • Yearbook pages
 
  1. PHOTOGRAPH
    A recent color 4x6 head shot must be stapled to the upper right-hand corner of the application form with complete name and state written on the back of the photo. Please place the staple at the very top of the photo and not on the image.
 
  1. SIGNED APPLICATION
    Once you have completed the application and printed it out, it must have the following three signatures.
Applicant Signature
In submitting these materials, I certify that all of the information submitted in support of my application is complete and accurate to the best of my knowledge. False information will result in termination of the scholarship if granted.

 

(Student's Signature)                                                    (Date)

Parent/Guardian Approval
I certify that the information provided by the applicant is complete and accurate to the best of my knowledge.

 

(Parent/Guardian Signature)                                         (Date)

School Official Certification
I certify that the information provided by the applicant is accurate to the best of my knowledge.  This student is in good standing with the school.

 

(Principal or Guidance Counselor's Signature)              (Date)

 
 

COMPLETED APPLICATION
Please check the boxes below to make sure that you include ALL the required materials before you mail your application.

PLEASE MAIL COMPLETE APPLICATION MATERIALS
IN ONE 9X12 ENVELOPE TO:
The Freedom Forum
Attention:  Al Neuharth Free Spirit Scholarship and Journalism Conference Program
555 Pennsylvania Avenue, NW
Washington, DC  20001
 
AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED.
 
DEADLINE:  POSTMARKED NO LATER THAN OCTOBER 15, 2009
 
STUDENTS MUST ATTEND THE ENTIRE CONFERENCE SCHEDULED FROM MARCH 13-18, 2010 TO RECEIVE THE SCHOLARSHIP.
 
If you have any questions, please send an e-mail to
freespirit@freedomforum.org or call 202/292-6261
 
The Freedom Forum makes all scholarship determinations without regard to race, color, religion, sex, national origin, age, disability or any other protected classification.
 
PLEASE REVIEW ALL INFORMATION BEFORE CLICKING "SUBMIT." YOU CANNOT MAKE CHANGES ONLINE AFTER SUBMISSION.