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APPLY ONLINE at http://bmoawheelsofdreams.org Mail in all documents – Read instructions carefully to see what applies to what you are applying for.

BACKGROUND The Wheels of Dreams Youth Foundation (WODYF) is a 501(C)(3) nonprofit organization led by members of the Black McDonald’s Owners Association. The mission of the Wheels of Dreams Youth Foundation is to provide positive role models, mentors, entrepreneurial skills, and employment opportunities to youth. The WODYF annually sponsors a scholarship program for high school seniors from communities that may face limited access to educational and career opportunities. ELIGIBILITY Currently enrolled high school senior with at least a 2.5 overall grade point average. PLEASE NOTE: In order to be eligible for the scholarship program, the applicant must serve as a legal U.S. resident residing within the 19 counties that comprise metro Atlanta. Eligible students must submit a complete application and attach all of the required documentation or their application will not be reviewed. Application must be postmarked no later than date provided by WODYF educator. The Wheels of Dreams Youth Foundation will award (2) $1,000.00 scholarships. Recipients will be required to the meet advisory board for a face-to-face interview. Scholarship recipients must enroll in and attend a two- or four-year accredited college/university, or vocational/technical school in the academic year following their selection. Verification of enrollment is required. Scholarship funds will be paid via check directly to the accredited institution in which the student enrolls. Scholarship funds will not be paid directly, nor reimbursed to a reward recipient.

SUPPORTING DOCUMENTS REQUIRED  Applicants must submit a completed application, signed and dated. Any incomplete applications will not be considered.  Student Scholarship Application  Personal Statement (max: 1000 words)  Letter of Recommendation (1)  Official Transcript (minimum 2.5 GPA) CERTIFICATION AND RELEASE All applicants and their parents or guardians (if under 18 years of age) must sign the application certifying that all information provided is true and complete to the best of their knowledge. Upon submission of the completed application, the applicant grants the Wheels of Dreams Youth Foundation the right to use the application information as legally required or permitted by law and authorizes use of applicants’ likeness and image to promote the BMOA Wheels of Dreams Youth Foundation and its programs. SUBMISSION OF THE APPLICATION 1. Online: students can download PDF file online at http://bmoawheelsofdreams.org 2. Hard Copy: All complete applications must be postmarked by May 10th the required deadline provided by the WODYF educator. Incomplete applications will not be considered. Applications must be sent to: Wheels of Dreams Youth Foundation C/O In School Spirit PO Box 360718 Decatur, GA 30036 NOTE: To ensure timely delivery, applications should be sent via certified mail with return receipt.

Stay connected with Wheels of Dreams! @WODYF

© Wheels of Dreams Youth Foundation

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Scholarship Application

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APPLICANT INFORMATION & DEMOGRAPHICS Please print or type. *Indicates a required field.

APPLICANT INFORMATION

*Are you currently a high school senior?

*Email Address: _____________________________________________

Yes

No

Your email address is required for the data entry process. If you do not provide this information, your application may not be considered.

*First Name: _________________________________________________ Middle Name: ________________________________________________ *Last Name: __________________________________________________ *Permanent Mailing Address: ______________________________ ________________________________________________________________ *City: _________________________________________________________ *State: ________________________ *Zip: _________________________ *County: ______________________________________________________ Please provide the name of the county in which your current city of residence is located.

*Are you a legal resident?

Yes

No

_____________________________________________________________ HOW DID YOU HEAR ABOUT THE WODYF PROGRAM? ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

_____________________________________________________________ FAMILY INFORMATION Applicant’s place of birth: *City: ____________________________________________________________

*Home Phone Number: _____________________________________

State (if applicable): ___________________________________________

*Cell Phone Number: ________________________________________

*Country: _______________________________________________________

*Date of Birth: _______________________________________________ Ethnicity/Nationality (optional): __________________________ Gender:

Male

Female

Parent/Guardian #1: First Name: _____________________________________________________ Last Name: _____________________________________________________ Relationship: ___________________________________________________ Phone Number: ________________________________________________ Parent/Guardian #2: First Name: ____________________________________________________ Last Name: _____________________________________________________ Relationship: ___________________________________________________ Phone Number: ________________________________________________



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APPLICANT INFORMATION & DEMOGRAPHICS Please print or type. *Indicates a required field.

HIGH SCHOOL

If still in high school, please provide the information for the high school you are currently attending.

SCORES *Is your GPA Weighted or Un-Weighted? ____________________

*High School Name: _________________________________________

*GPA Scale: _____________________________________________________

________________________________________________________________

*GPA: ___________________________________________________________

*High School Address: ______________________________________

*Does your school rank students?

________________________________________________________________ *High School City: ___________________________________________ *High School State: ____________________ *Zip: _______________ High School Counselor’s Name: ____________________________

If yes, please answer the following questions:

Yes

No

*Class Rank: ___________________________________________ *Class Size: ____________________________________________ *Have you taken the ACT or SAT?

If you have taken both, please provide information for all.

________________________________________________________________

ACT

Composite Score _________________

High School Phone Number: ________________________________

SAT

Critical Reading Score ___________

*Graduation/Completion Date: ____________________________ INSTITUTION INFORMATION

If you have not finalized your college choice, provide your first choice school.

*Institution State: ___________________________________________

Math Score ________________________ Written Score _____________________ I am not required to take the ACT/SAT.

_____________________________________________________________

*Institution Name: __________________________________________ ________________________________________________________________ *Major: _______________________________________________________ *Minor: _______________________________________________________



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COMMUNITY INVOLVEMENT Please print or type. COMMUNITY/VOLUNTEER SERVICE (REQUIRED) List at least one and up to five agencies or organizations in which you have participated without pay during the last three years (religious groups, hospital volunteer, cultural activities, outreach programs, etc.) Enter total hours per activitiy over the last three years. Do not use acronyms. All fields are required for each community/volunteer service listed below.

1. Service Description: _________________________________________________________________________________________________ Start Date: __________________________

End Date: ____________________________

Contact Name: ______________________________________________

Total Hours: _____________________

Contact Phone Number: _________________________

Contact Email: _______________________________________________________________________________________________________ 2. Service Description: _________________________________________________________________________________________________ Start Date: __________________________

End Date: ____________________________

Contact Name: ______________________________________________

Total Hours: _____________________



End Date: ____________________________

Contact Name: ______________________________________________

Total Hours: _____________________



End Date: ____________________________

Contact Name: ______________________________________________

Total Hours: _____________________



End Date: ____________________________

Contact Name: ______________________________________________

Total Hours: _____________________


Contact Email: _______________________________________________________________________________________________________



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COMMUNITY INVOLVEMENT continued Please print or type.

WORK EXPERIENCE (REQUIRED) List the last three jobs you have held the longest (food server, babysitting, lawn moving, office work, etc.) Do not use acronyms. All fields are required for each work experience below. 1. Employer Name: ____________________________________________________________________________________________________ Position: __________________________________________________ Start Date: _______________________________________

Avg. Hours/Week: ____________________________ End Date: _______________________________________________

Contact Name: __________________________________________ Contact Phone Number: ______________________________ Contact Email: _______________________________________________________________________________________________________ 2. Employer Name: ____________________________________________________________________________________________________ Position: __________________________________________________ Start Date: _______________________________________


Contact Name: __________________________________________ Contact Phone Number: ______________________________ Contact Email: _______________________________________________________________________________________________________ 3. Employer Name: ____________________________________________________________________________________________________ Position: __________________________________________________ Start Date: _______________________________________


Contact Name: __________________________________________ Contact Phone Number: ______________________________ Contact Email: _______________________________________________________________________________________________________



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COMMUNITY INVOLVEMENT continued Please print or type. EXTRACURRICULAR ACTIVITIES (REQUIRED) List up to five activities in which you have had the most involvement in the last four years (school clubs, student government, publications, varsity or club sports, theater arts, Scouting, etc.). Do not use acronyms. All fields are required for each extracurricular activity listed below. 1. Activity Description: ____________________________________________________________________________________________________ Highest Position Held: __________________________________________________

# of Years Involved: _____________________

Contact Name: __________________________________________ Contact Phone Number: ___________________________________ Contact Email: ___________________________________________________________________________________________________________ 2. Activity Description: ____________________________________________________________________________________________________ Highest Position Held: __________________________________________________








Contact Name: __________________________________________ Contact Phone Number: ___________________________________ Contact Email: ___________________________________________________________________________________________________________ © Wheels of Dreams Youth Foundation


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FINANCIAL INFORMATION Please print or type. PARENT/GUARDIAN FINANCIAL DATA

PERSONAL STATEMENT

Total Annual Household Income ________________________

Please include a personal statement detailing how you have acted as an exemplary role model in your community and the initiative you have taken to fulfill your educational goals. Maximum word count of 1,000 words. Pay close attention to both content and word count when writing your essay. For best results, type your essay in your choice of text editor (Example: Microsoft Word) and include it with your application. It is highly recommended that you have an advisor or teacher read over your essay before submission.

Total number of family members living in household and primarily supported by the reported income: _______ Total number of family members attending college at least part-time during the next school year, including applicant: __________ Marital Status of parent(s) or guardian(s): Married

_____________________________________________________________

Divorced Separated Widowed Single

___________________________________________________________ OTHER SCHOLARSHIPS

Please list other scholarship programs for which you have applied.

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________



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