The Student Sage Scholarship

Nomination Form 2010

School Name:*
School Address:*
Address Line 2:
City:*
State / Zip:* /
School Contact:*
Title:
Telephone:*
Email:
Date of Award Ceremony:
Ms.
Nominee:*
Nominee Address:*
Address Line 2:
City:*
State / Zip:* /
Nominee Telephone:
Nominee Email:
Citizenship / Country:*
(Must be a U.S. citizen or permanent resident)
Intended Major or Unknown:*
Academic Achievements:
Grade Point Average:*
(Through 5 semesters - GPA must average at least a B+ in academic courses only)
Rank in Class:
(If applicable - Candidates should rank in the top 25% of their class)		 /
Weighted Unweighted
PSAT or SAT Score:
(Highly recommended, if available - Candidates should score at about or above the national average (1000))		 Verbal
Math
Writing
Leadership and Community Service:
(Activity, Years Involved, Leadership Role)
Recommendation from School Counselor or Principal*
(at least one paragraph)

I certify that this student has at least a B+ average in academic coursework (Math, English, History, Science and Language)

I certify that this student has scored, or in my estimation has the aptitude to score, at least the national average on the math and verbal portions of the SAT (1000)

I understand that all scholarship awards are contingent upon verification of academic qualifications