The Kansas State Delta Chi Educational Foundation
Wichita High School East International Baccalaureate
Outstanding Student Leadership Scholarship

Name ___________________________________________ Phone number( _____)________________

Address _____________________________________________________________________________

Annual household income $_______________ Composite PSAT/SAT/ACT ______/______/_______

Financial Aid and/or scholarship money received $_______________per_______________________

Extended Essay topic and curriculum _____________________________________________________

Total CAS Community Service Hours (Creativity/Action/Service) _________/________ /_________

Intended major at Kansas State University _______________________________________________

Please list any high school activities in which you have been involved and any leadership roles
you have held (attach extra page if necessary).

Please list scholastic achievements, awards and honors

Please attach the following information (no more than one page for items number 2 or 3).

1. A copy of your most recent transcript listing all SL and HL courses
2. A letter of recommendation from your extended essay advisor.
3. A letter from the IB counselor or administrator regarding your potential for graduating
   with an IB diploma and confirmation of the above listed information.
4. A personal statement about yourself explaining why you believe you deserve the Delta
   Chi KSU Outstanding Student Leadership Scholarship (200 words or less)

"I hereby verify that the above information is true and accurate to the best of my knowledge."

Please sign and return by February 11, 2000 to the address below.

Date __________ Signed ___________________________________

Please return application with all attachments to: