Community Foundation of Howard County General Scholarship Application Information

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1 Community Foundation of Howard County General Scholarship Application Information Go to for complete criteria requirements for each scholarship. If additional information is required, it must accompany this application. Any Howard County High School Carl Anderson Scholarship: Students pursing a bachelor s degree in education. M. Joyce Cook Memorial Scholarship: Students pursuing a bachelor s degree in elementary education, ministry or the mission field. William S. & Susannah B. Hough Memorial Scholarship: Students who will attend Indiana University- Kokomo, Purdue University-Kokomo, or Ivy Tech Community College-Kokomo. First-year applicants must submit a copy of the college acceptance letter. Howard - Tipton Central Labor Council Scholarship: Howard and Tipton County students who will be attending any accredited post-secondary institution. Applicants may be union members or have a parent or guardian who is a member of a labor union. Written verification of current union membership on union stationery signed by union officer must be submitted with the application. Knolinski Family Scholarship: Students pursuing a degree in mathematics, accounting, science and/or engineering. Kathy A. Name Memorial Scholarship: Students pursuing a degree to become a registered nurse. Donald B. Smith Memorial Scholarship: Students pursing a bachelor s degree (preference given to students majoring in business). Helen and Morris Stout Scholarship: Students seeking an education beyond high school. Thacker Memorial Scholarship: Students pursuing a degree from Indiana University-Kokomo, Purdue University-Kokomo, Indiana University-Bloomington, Purdue University in West Lafayette, or Indiana University Purdue University-Indianapolis. Wiese Oldsmobile and GMC Truck, Inc. Scholarship: Students who will attend Purdue University. First-year applicants must summit a copy of their acceptance letter. R. Franklin Zehring Scholarship: Students who graduate or obtain a GED and who will be attending school in Indiana. Eastern High School James F. & Janet G. Smith Trust Scholarship: Students attending Indiana University-Kokomo. Kokomo High School W.G. Harter Memorial Scholarship: Students pursuing a bachelor s degree in engineering including engineering technology at an Indiana school. Preference will be given to students attending Purdue University. C.V. Haworth Memorial Scholarship: Students who plan to attend Indiana University-Kokomo or Indiana University Bloomington. John Pitzer Scholarship: Students who are or will be attending Indiana University. Sadie A. Townsend Memorial Scholarship: Students who are in the top 10% of their graduating class and pursuing a bachelor s degree.

2 Community Foundation of Howard County General Scholarship Application Information Go to for complete criteria requirements for each scholarship. If additional information is required, it must accompany this application. Kokomo and Taylor High Schools Richard Crosser Memorial Scholarship for KHS & THS: Students pursuing a two- or four-year degree in structural engineering, architecture, building trades, real estate, drafting, business, finance, accounting, or some other field related to building trades at an Indiana college or university. Northwestern High School Richard L. & Marion J. Eller Scholarship: Residents of Clay, Ervin and Howard townships who plan to attend college or trade school in Indiana. Preference given to students pursuing a degree in agricultural-related studies. Taylor High School Tony Gabriel Student Athlete Scholarship: Students who have participated in any varsity sport(s) for two or more years and who have maintained a 7.0 or higher GPA on a 12.0 point scale. First-year applicants must submit a copy of the college/university acceptance letter. Danny M. Keating, Sr. Memorial Scholarship: Students who are or will be enrolled in an accredited educational institution for a minimum of one year. Recipients must have participated in a varsity sport and earned at least one varsity letter. Frederick E. Wideman, M.D. Student Athlete Scholarship: Students who have participated in any varsity sport(s) for two or more years and who have maintained a 7.0 or higher GPA on a 12.0 scale. Recommendations from the student's head coach and the high school principal/faculty advisor are required. Western High School Kathie Beatty Memorial Scholarship: Students who plan to attend Purdue University-Kokomo, Indiana University-Kokomo, or Purdue University-West Lafayette. Hamilton-Middleton Scholarship: Students pursing a business- or history-focused education. Betty Lou James Scholarship: Preference given to students who have studied family and consumer sciences and who plan to continue in this field. If no one fits this criteria, then students who have studied family and consumer sciences and who major in education will be considered. Linda F. Pagel Memorial Scholarship: Students graduating from Western or Tri-Central high schools who are going to attend any Indiana college or university. Kathy Ann Pylat Scholarship: Students who are or will be attending any accredited four-year statesupported college or university in Indiana. Western High School Class of 1962 Scholarship: Students attending any accredited college or university. Western High School Class of 1963 Scholarship: Students attending any accredited college or university.

3 Applicant's Name: Last First The Community Foundation of Howard County, Inc General Scholarship Application Please check the scholarship(s) you are applying/eligible for: ANY HOWARD COUNTY HIGH SCHOOL KOKOMO AND TAYLOR HIGH SCHOOLS Carl Anderson Scholarship Richard Crosser Memorial Scholarship M. Joyce Cook Memorial Scholarship NORTHWESTERN HIGH SCHOOL William S. & Susannah B. Hough Memorial Scholarship Richard L. & Marion J. Eller Scholarship Howard-Tipton Central Labor Council Scholarship TAYLOR HIGH SCHOOL Knolinski Family Scholarship Tony Gabriel Student Athlete Scholarship Kathy A. Name Memorial Scholarship Danny M. Keating Sr. Memorial Scholarship Donald B. Smith Memorial Scholarship Frederick E. Wideman, M.D. Student Athlete Helen and Morris Stout Scholarship WESTERN HIGH SCHOOL Thacker Memorial Scholarship Kathie Beatty Memorial Scholarship Wiese Oldsmobile and GMC Truck Scholarship Hamilton-Middleton Scholarship R. Franklin Zehring Scholarship Betty Lou James Scholarship EASTERN HIGH SCHOOL Linda F. Pagel Memorial Scholarship James F. & Janet G. Smith Trust Scholarship Kathy Ann Pylat Scholarship KOKOMO HIGH SCHOOL WHS Class of 1962 Scholarship W.G. Harter Memorial Scholarship WHS Class of 1963 Scholarship C.V. Haworth Memorial Scholarship John Pitzer Scholarship Sadie A. Townsend Memorial Scholarship Please complete and return this form to: Community Foundation of Howard County, Inc. 215 W. Sycamore Street Kokomo, IN Application must be received by: March 29, 2013 If you have questions, you may contact the Foundation office by phone at: (765) or Web site:

4 Note to Applicants: In order to be considered for this scholarship, you must type (or print in ink) your responses on the application. In addition, you must provide all required information by the application deadline. Incomplete applications and applications filled out in pencil will not be considered. CERTIFICATION OF APPLICATION If I receive this scholarship, it is my intent to pursue a post secondary education at a post secondary educational institution. The Community Foundation of Howard County, Inc. has my permission to use any general, non-financial information included in this application for publicity purposes. In addition, I agree to provide the foundation with photographs. If I receive this scholarship, I understand that I represent the Community Foundation of Howard County, and therefore, I am expected to maintain high standards of conduct in accordance with state and federal laws. I further understand that failure to do so may result in the termination of this scholarship. Applicant's signature: Date: (PLEASE TYPE OR PRINT THE FOLLOWING DATA) Personal Profile Name Date of Birth / / Address Street City State Zip Phone ( ) Cell Phone ( ) Name of father Address if different from student Employer Position Highest school father completed Middle school/jr. High High School College or beyond Other/unknown Name of stepfather/guardian (if applicable) Address (Circle one) Name of mother Address if different from student Employer Position Highest school mother completed Middle school/jr. High High School College or beyond Other/unknown Name of stepmother/guardian (if applicable) Address (Circle one) Check if applicable ( ) Father deceased ( ) Mother deceased ( ) Parents divorced - ( ) Year of divorce Family Information Number of brothers and sisters: Younger: Older (If dependent) Ages of brothers and sisters: Name of College and/or University (s) to which you have applied (please list in order of preference) and circle those to which you have been accepted: 1) 2) 3) Intended major or course of study:

5 Scholastic Profile High School Name Graduation Date: Month Year You must include an original copy of your high school transcript of grades and have the following section completed by the appropriate school offi cial. Applicant Ranks in a class of SAT/ACT + + = Cumulative Grade Point Average (4.0 scale) Math + Verbal + Written = Total SAT School Official Signature Date Title Phone ( ) Financial Data for 2012 Student's Income Mother's Income Father's Income If applicable: Stepfather's Income Stepmother's Income If additional questions should arise with regard to the financial data requested, the foundation reserves the right to request for review a copy of the most recent tax return filed by the applicant, or the applicant's parents, if dependent. Estimated Financial Resources: List any other financial assistance being received in the form of grants, scholarships and/or loans. Please indicate if these awards are one-time or renewable awards. Type of Assistance Source Amount Are you a 21 st Century Scholar? Yes No Do you prefer to attend a private college or university? Please report any unusual family/personal/financial circumstances you want the committee to consider: Work experience - List places of employment over last 4 years. Company From/To Hours Per Week Amount Earned

6 Extracurricular Activities/Community Involvement - List activities in the order of significance starting with the most significant. Please describe your involvement, including any leadership positions held in school, community, civic, or church organizations during the past 4 years. Do not attach a separate sheet. Use the space provided below. Activity # of yrs./# of hrs. per yr. Activity # of yrs./# of hrs. per yr. Awards & Honors - List all awards and honors you have received (school & otherwise) the last 4 years. Essay Answer in essay form the following: (You may use additional paper if necessary.) 1. What career are you thinking about? 2. What are your professional goals as you enter college and what has influenced you to choose those goals? 3. Pagel Applicants: What influenced you to pursue a career in teaching or a health-related field? Recommendations Recommendation letters (no more than three) must be included with your application; Must be submitted from someone other than a relative and at least one should be from a teacher and/or administrator from your high school. Application Checklist This application for a scholarship becomes complete and valid only when completed in its entirety with all required attachments: [ ] Student Application & Essay [ ] Original Transcript of Grades [ ] Letters of Recommendation [ ] Signed Application [ ] Additional Requirements as noted in the criteria Eligibility Requirements: A child, step-child, grandchild, step-grandchild, great grandchild, step-great grandchild, spouse, brother, sister, and spouses of everyone listed previously of someone who during the last five years has served as a member of the Scholarship Committee, Howard County high school staff that has been associated with the selection of scholarships awarded by the Community Foundation of Howard County, Inc., been a board member or a regular full-time and/or regular part-time employee of the Community Foundation of Howard County, Inc., is not eligible for scholarships awarded by the Community Foundation.

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