Illinois Patriot Education Fund Scholarship Application

Transcription

1 Scholarship Application Thank you for your service and sacrifice to our country. The, a 501 (C) (3) charity incorporated in the State of Illinois, provides financial assistance supporting the educational journey for Illinois military service men and women who have given their lives or become disabled in service to our country and their families. We also support the education of active duty members, veterans, their spouses, and their children over and above the benefits provided by the Post-911 GI Bill. To ensure you qualify for an IPEF Scholarship, you must be in one of the categories listed above. To ensure we have all the information needed and in the order needed for evaluation, please complete this application in full and follow the instructions, paying close attention to the required forms needed and timelines for submission. If any forms requested are missing, your application packet may be immediately declined or returned for resubmission. Once completed, please submit all your information to the Scholarship Committee as follows: By Mail: By N. Lincoln Ave. Suite 436 Chicago, IL Application Deadlines are on the final page of the application. 1. Applicant s Full Name: LAST NAME FIRST NAME MIDDLE INITIAL 2. Applicant s Complete Address: STREET ADDRESS STREET ADDRESS (SECOND LINE) CITY STATE/PROVINCE POSTAL CODE/ZIP CODE COUNTRY PHONE ADDRESS 1

2 3. Date to graduate (or graduated) from high school: 4. Semester applying for: 5. Date to enter (or entered) college: 6. Name of college(s) (currently attending or applying to) and proof of or means to verify the accreditation of the college (attach acceptance letter): 7. Number of years of college completed (if any): 8. Indicate which scholarship category you are applying for: q I am applying for a scholarship as an Illinois active duty or veteran who went into military service from the State of Illinois and returned back to reside in the State of Illinois post service. Applicant must provide current proof of residence (state I.D.) and military service record (valid military Title 10 or Title 32 form with a valid Military/Govt. issued ID or a DD214). q I am applying for a scholarship as a spouse or child of a service member who was wounded, disabled, or killed in the line of duty who joined the military while living in the State of Illinois and the spouse and/or dependents currently reside in Illinois. Must provide proof of residency (state I.D.) and military service record (DD214 of the Military Service member) *Any spouse or dependent of a post 9/11 veteran is able to apply for a scholarship and will be assessed based on a financial needs assessment. 9. Provide any test scores, such as your official SAT, ACT, GRE or other academic measures. (Please mail us a copy of your official scores and academic records directly from the school or testing center to the mailing address at bottom of page.) Test and Score Date 10. List your extracurricular or volunteer activities (include additional descriptions or details as attachments): 2

3 11. Personal essay is required. (Include actual essay as a word document attachment, at most 2 pages, single-spaced, 12-point type; may be less, such as double-spaced) Essay Question: Tell the IPEF Scholarship committee the importance of what service to country means to you personally. Inform the committee about your goals once you graduate. Finally, summarize how this scholarship will impact you. 12. List the contact information of 1-2 references (3 max). One should be a friend/non-relative and the second should be a current or past work/military supervisor. Each reference must send us an with the applicant s full name at the top of the reference letter describing why you should receive a scholarship. The letter must be an attachment in a word doc, 1 page, singlespaced, 12-point type; may be less, such as double-spaced): The letters must be ed to The timeline for submission will be detailed below. First reference: , name and phone number Second reference: , name and phone number (Optional) Third reference: , name and phone number 13. Any general comments you wish to include to the selection committee? (You may also include as an attachment, limited to one page: single-spaced, 12-point type; may be less, such as double-spaced) 14. I have signed and submitted the attached "Assignment of Rights & Consent to Publish Scholarship Information": Yes / No 3

4 Application Submission Deadlines Scholarship application, proof of service/residence, essay and reference letters must be post dated in the mail, or ed to no later than May 31st. If there are any questions regarding this process you may but expect a 24-hour response to your question. If you are selected to pass through the 1 st round into the second round, there may be additional requirements to provide the committee before a final decision will be made. Thank you for applying to the Scholarship Committee. You will receive a confirmation that we have received your packet in full. If the packet is not completed in full with all required documents, your application may be declined upon receipt or sent back to complete the missing sections. If the committee gives you the option to resubmit, you will have 24 hours to resubmit via (only). Due to limited resources, only a certain number of applicants will be selected each semester. Thank you for your service. Remainder of page left blank. Please sign application on final page. 4

5 ASSIGNMENT OF RIGHTS & CONSENT TO PUBLISH SCHOLARSHIP INFORMATION KNOW ALL PERSONS BY THESE PRESENTS: THAT I, _, do hereby give the full rights to publish my name, where I live (city, state, and country only; actual street addresses and phone numbers will not be disclosed), my branch of service or branch of spouse or parent s branch of service, pertinent family information, college I am attending, photographs that I have provided, and college updated information. If accepted as an IPEF scholar, you will be required to provide a bio for us to publish on our scholar recipient page telling your story. If accepted, IPEF scholar will be required to provide grades and show forward progress while receiving scholarship funds. I fully understand that all scholarship funds will be paid directly to the school and that no funds, at any time will be disbursed to me directly. I also must notify IPEF of any early withdraw or change in current enrollment at your school. Failure to do so will immediately disqualify you from applying for a scholarship again from IPEF. I understand that by execution of this agreement, I am relinquishing my rights to any future compensation for reproduction, publication or use of the above information by the Illinois Patriot Education Fund, a 501 (C) 3 charity, in its print or electronic correspondence, catalog, or on its website. I hereby specifically waive my right to review or approve THE MODIFICATION of the above Information. (Modifications may be made to accommodate size or content restrictions. Modifications will not be made to distort or falsify any information provided.) I understand that this Agreement in no way obligates the to publish or use the above-described information. EXECUTED this date of. By: (Print Name) (Signature) Witness: (Print Name) (Signature) 5