Southern Nevada Mensa
2012 – 2013 Scholarship Essay Contest Entry Form


If you prefer, click on the icon below to download a PDF version of the Application Form.

Please complete the entry form below. This entry form MUST be typed or printed legibly and signed.


NAME _______________________________________________________________   AGE _________


CITY _______________________________________________   STATE ____   ZIP __________  

PHONE (____) ____-_______

EMAIL ADDRESS (If any) ________________________________________________________

PRESENT ADDRESS (If different from above)

CITY _______________________________________________  STATE ____   ZIP __________  

PHONE (____) ____-_______

PRESENT EDUCATIONAL LEVEL (Circle one)  High School   College 1 2 3 4   Graduate School



DEGREE MAJOR: _____________________________________________________________

School presently attending:

NAME ______________________________________________________________________

ADDRESS __________________________________________________________________

School to be attending in Fall 2012, if different than above and known:

NAME ______________________________________________________________________

ADDRESS __________________________________________________________________


Awards are made on the basis of an essay of no more than 550 words that describes the applicant’s career, vocational or academic goals. It is NOT necessary that the applicant be a member of Mensa. The eligibility requirements are that the applicant be enrolled, for the academic year following the award, in a degree program in an accredited U.S. institution of post-secondary education, and reside in the domain of Southern Nevada Mensa (ZIP codes 86400-86434, 86436-86499 or 89000-89299). The general awards are unrestricted as to age, race, gender, level of post-secondary education, grade point average or financial need. Winners MUST provide proof of school enrollment for Fall/Spring 2012-2013 prior to payment of the award.



I certify that the accompanying essay is solely my own work, that I have read and understand the rules and conditions set forth on Page 2 and have met all of them. I agree to accept the decisions of the judges as final. I understand that any award may be revoked for failure to provide appropriate documentation regarding educational status.

I understand that Southern Nevada Mensa is not responsible for late delivery or other errors by the U.S. Post Office. I agree that Southern Nevada Mensa may print my essay in any Mensa publication, may submit appropriate publicity releases to the media and may post my essay and contest results on any Mensa web site. All essays become the property of Mensa and cannot be returned.
Signature of Applicant: ______________________________________________  Date: _________________________


Send completed entry form (both pages) and essay to:

M. Russell Bakke
2813 Brianwood Court
Las Vegas, Nevada 89134
Scholarships @



1. The applicant must currently reside in one of the following zip codes: 
                 86400 - 86434       86436 - 86499       89000 - 89299
     Only one entry is allowed per student to this public award competition.

2. The applicant must be intending to enroll in an accredited U.S. institution for the 2012-2013 academic year.

3. The essay must be the applicant’s original work and no more than 550 words in length.

4. Essays must be typewritten or computer-generated as a single-sided document on white paper (20 lb.) with double spacing. Leave at least 1” margins all around. Please do NOT staple pages and please use at least a 12 point font.

5. The applicant’s name, address or other identifying information MUST NOT be included in the essay or on the essay paper, front or back. Identifying information is to appear only on the application entry form.

6. The applicant must complete the information on Page 1 of this form, sign where indicated and submit the signed entry form along with the essay. Do not include anything else besides a stamped, self-addressed postcard if you want acknowledgement of receipt of your entry. Any other included materials will be discarded and not be considered.

7. Materials must be postmarked, regular US Post Office delivery, no later than May 24, 2012. Metered mail received after the deadline and special delivery mail may not be accepted. Southern Nevada Mensa is not responsible for late delivery and/or any other error made by the US Post Office.

8. Do not contact the judges concerning this competition. Judging is done blind and without knowledge of who has entered the competition. Do not contact the scholarship chair about the competition beyond asking for a clarification of the rules. Such contacts may disqualify you from the competition.  Only essays that conform to the rules and guidelines will be considered.  Submissions cannot be returned. Winners will be notified by mail by the end of June 2012.  No materials other than the essay, the entry form and optional proof of receipt are to be submitted. The decision of the judges is final.
JUDGING WILL EMPHASIZE a goal statement that includes specific information on experience or steps taken toward the goal, persuasiveness (e.g., how your past achievements/experiences and your future planning increase the probability of reaching your goal), why you believe you will succeed, as well as grammar, spelling and punctuation.

© 2012 Southern Nevada Mensa.  All rights reserved.