2023 Leigh O. Cortez Educational Leader Scholarship

Personal Information

Name*

First Name Middle Last Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Cell Phone

Email

Current Teaching Information

Name of District Where Currently Teaching:

Name of School:

Current Grade Level:

Number of years teaching:

Past Teaching Experience

Work Experience:

Name of School/District	Dates (from/to)	Grade Levels Taught

Educational Experience

Educational Experience:

Name of College/University	Years Attended	Degree Earned

Honors & Activities

Honors and Award Achievements:

Please list any honors or awards you have received while teaching.

Community Service Activities

Name of Organization	Dates (from/to)	Average hours per month	Activities / Positions

Please list any involvement with nonprofit, community, civic and/or faith-based organizations.

Graduate Work

Name of University	Graduate Program	Accepted Yes/No	Intended start date

Please provide information on the graduate programs to which you have or are applying for this scholarship.

Personal Statement

In the space above, please describe your educational experience and how a graduate degree in education will help you with your career goals. (maximum 500 words)

Financial Need Statement

In the space above, please describe your financial situation and how this scholarship would benefit you. (maximum 350 words)

Applicant Signature

Date

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