2011/12 SCHOLARSHIP GUIDE & APPLICATION SOUTHERN INDIANA CAMPUS

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1 Changing Lives. Building Futures. The Ivy Tech Southern Indiana campus expansion; inspired by the past in service of the future. 2011/12 SCHOLARSHIP GUIDE & APPLICATION SOUTHERN INDIANA CAMPUS Scholarship Guide

2 November 9, 2010 Dear Scholarship Applicant: On behalf of Dr. Rita Hudson Shourds, chancellor of Ivy Tech Community College Southern Indiana, I would like to thank you for allowing the college to give you the education you need in order to maximize your full potential. Ivy Tech Southern Indiana is committed to you receiving the very best in educational attainment, exemplified by our excellent faculty and staff members who work with our students on a daily basis at the college. We all want the best for you and your future. As you review this Scholarship Guide, I would like to encourage you to ask questions along the way. The wide array of student scholarships represents the commitment our generous donors have to your educational experiences at Ivy Tech Southern Indiana. Like everyone associated with the college, they want you to succeed. As you are well aware, education is vital in today s world. Your decision to advance yourself educationally is one of the best choices you can make. We are proud of your choice. Sincerely, Andrew B. Takami Executive Director of Resource Development 8204 HIGHWAY 311 SELLERSBURG IN Ivy Tech is an accredited, equal opportunity, affirmative action community college.

3 Scholarship Guide IVY TECH COMMUNITY COLLEGE SOUTHERN INDIANA The Ivy Tech Community College Southern Indiana Scholarship Guide provides detailed information on scholarships available to Southern Indiana students. To apply for scholarship(s), please complete the application on the last page of this guide. PLEASE REMEMBER You must complete one application form for EACH scholarship you plan to pursue. QUESTIONS If you have questions, please contact Office of Development (812) , extension 4212 or call toll free 1(800) WEB ACCESS The Ivy Tech Southern Indiana Scholarship Guide information is also available online at APPLICATION DEADLINE March 13, 2011 SCHOLARSHIP DOCUMENTATION &APPLICATION It is a student s responsibility to complete an application for each scholarship and submit documentation supporting eligibility. Documentation can be high school transcripts or unofficial college transcripts. ALL APPLICATIONS MUST HAVE A TRANSCRIPT ATTACHED. If you are a current Ivy Tech Southern Indiana student, you may obtain an unofficial transcript at To be eligible for any of the scholarships, a current Ivy Tech Southern Indiana student must be seeking an Associate Degree or Technical Certificate. Undecided students will not be awarded monies. For additional information on financial aid please visit: www. fafsa.gov and for scholarship information, please visit: www. fastweb.com. Scholarship Guide Information This information is true and correct at the time of publication. Ivy Tech Southern Indiana reserves the right to make modifications to this information based on funding allocations and donor specification changes in the eligibility criteria. Ivy Tech Southern Indiana is an accredited, equal opportunity/ affirmative action institution of higher education. General Information Thank you for choosing Ivy Tech Southern Indiana to further your education. Whether you plan to transfer to a four-year institution, obtain employment, add to your education or update your skills, Ivy Tech Southern Indiana offers the knowledge and skills you need to succeed. Ivy Tech Southern Indiana provides a variety of scholarship opportunities to students. They are made possible through the Ivy Tech Foundation Southern Indiana, the Paul Ogle Foundation, the Community Foundation of Southern Indiana, the Harrison County Community Foundation, the Scott County Community Foundation and various donations from Southern Indiana businesses and individual donors. The information in this Guide describes the various scholarships available for the academic year. These scholarships are made possible by the generosity of donors who wish to encourage students along the path of lifelong learning and educational achievement. If you apply for a scholarship, please complete and submit the scholarship application form provided in the back of this Guide (along with the requested information by the deadlines listed). Be sure you meet all eligibility criteria for the scholarships you wish to pursue. HOW TO APPLY FOR SCHOLARSHIPS 1. Carefully review the information in this Guide. 2. Identify scholarships for which you are eligible and wish to apply. 3. Complete a Ivy Tech Southern Indiana Scholarship Application Form for each scholarship you are pursuing (provided in back of this Guide). Submit the completed application form and any additional information requested. Send to: Office of Development - Scholarships Ivy Tech Community College Southern Indiana 8204 Highway 311, Sellersburg, IN New students must complete the admissions process to Ivy Tech Southern Indiana including submission of high school transcript and ASSET/COMPASS Test (or waiver) by the application deadline. Please contact the Office of Admission if you have questions at (812) , ext Scholarship recipients will be selected based on the eligibility requirements for each scholarship. If you are a new student, your ASSET/COMPASS assessment scores will be used to determine eligibility for a scholarship. If you have submitted a waiver for the ASSET/COMPASS assessment, please submit your previous college transcripts. An unofficial transcript will suffice. You may submit SAT or ACT scores in lieu of the ASSET/COMPASS assessment. 1

4 Table of Contents SCHOLARSHIPS Brian Ray Kleehamer Memorial Scholarship... 3 Clark County REMC Scholarship... 3 Danny Hopkins Scholarship... 3 Don and Bobbie Perkins Scholarship... 3 Donna F. Reeves Scholarship SCHOLARSHIPS REQUIRING SEPARATE APPLICATION Coca Cola All-State Community College Academic Team Program... 8 Holmes Endowed Scholarship... 8 Jeffersonville Urban Enterprise Zone Scholarship THE APPLICATION PROCESS/CHECKLIST... 9 IVY TECH COMMUNITY COLLEGE SCHOLARSHIP APPLICATION Douglas L. Schleicher Scholarship... 3 Faculty/Staff Scholarship First Harrison Bank Scholarship... 3 Floyd Memorial Foundation Nursing Scholarship... 4 Floyd Memorial Hospital Marcella Miller Nursing Scholarship... 4 Ford/EEOC Endowed Scholarship... 4 Futures Unlimited Scholarship... 4 Gerrit Langemaat Scholarship... 4 Harrison County Hospital Foundation Scholarship... 5 Harvey S. Poling, Jr. Scholarship Homer B. Smith Scholarship... 5 Ivy Tech Community College High School Scholarship.. 5 Ivy Tech Community College County Scholarship... 5 Ivy Tech Community College/Prosser School of Technology Scholarship for Harrison County... 5 Jesse Ballew Family Scholarship Ken Staley Scholarship... 6 Legacy Award Scholarship Martha Hartstern Nursing Scholarship... 6 PNC Bank Scholarship... 6 Prosser School of Technology Scholarship... 6 Regions Bank Scholarship... 6 IVY TECH SOUTHERN INDIANA 8204 Highway 311 Sellersburg, IN (812) , extension Scott Memorial Hospital Scholarship... 7 Women s Foundation of Southern Indiana Scholarship

5 Scholarships Brian Ray Kleehamer Memorial Scholarship Be a student enrolled in an area of the health care field Be either an incoming student or a current student Have a financial need. A Free Application for Federal Student Aid (FAFSA) must be completed. Scholarship recipient shall be a United States citizen or permanent resident Maintain a 2.5 to 3.0 GPA in order to continue receiving the scholarship Clark County REMC Scholarship This scholarship is non-renewable. It is available through contributions of the Clark County REMC. Be a member of Clark County REMC at the time the scholarship is awarded; or, Reside in the home of a parent or legal guardian who is a Clark County REMC member and receives electric service from the Clark County REMC (The membership application must be in the name of a parent or guardian at the time the scholarship is awarded.) Be admitted to Ivy Tech Southern Indiana for the fall semester Have a GPA of 3.0 or higher on a 4.0 scale Clark County REMC scholarship is also open to the immediate family of any REMC employee or director who is an REMC member Danny Hopkins Scholarship This scholarship is dedicated to the memory of a former student of the college who was an automobile accident victim at a young age. The scholarship is held by the Ivy Tech Foundation and funded through donations by friends and family of Danny Hopkins. Be enrolled in Manufacturing & Industrial Technology in the Industrial Maintenance Specialty Minimum 3.0 GPA on a 4.0 scale and be enrolled on at least a half-time basis Don and Bobbie Perkins Scholarship Be enrolled in Advanced Manufacturing or Manufacturing and Industrial Technology Be either an incoming student or a current student Have financial need. A Free Application for Federal Student Aid (FAFSA) must be completed Recipient shall be a United States citizen or permanent resident Minimum 3.0 GPA on a 4.0 scale Donna Reeves Scholarship This scholarship honors the retired administrator of the nursing program at Ivy Tech Southern Indiana, Donna F. Reeves. Enrolled in the nursing program at Ivy Tech Southern Indiana Have a financial need. A Free Application for Federal Student Aid (FAFSA) must be completed Maintain a 2.5 GPA or above on a 4.0 scale Douglas L. Schleicher Scholarship This scholarship is available through the Ivy Tech Foundation and is renewable for the second year if the student maintains eligibility requirements. The Paul Ogle Foundation provides matching funds to the scholarship. Be an Allied Health major 1st preference is for Clark County residents 2nd preference is for Floyd County residents Minimum 3.0 GPA on a 4.0 scale Faculty/Staff Scholarship The Faculty/Staff Scholarship is made available through funds provided by the Faculty and Staff of Ivy Tech Southern Indiana and is held by the Ivy Tech Foundation. Minimum 3.0 GPA on a 4.0 scale Be a full-time student (12 credit hours or more) Must be a 2011 high school graduate Demonstrated student leadership potential May 2011 graduates must submit a copy of their high school transcript with application (five semesters or through first senior semester) First Harrison Bank Scholarship The Harrison County Community Foundation holds this scholarship through a match from the Paul Ogle Foundation. This scholarship supports Harrison County residents enrolled in a college program. First Harrison Bank may provide recommendations on an annual basis. Applicant must be a Harrison County resident Minimum 3.0 GPA on a 4.0 scale 3

6 Floyd Memorial Foundation Nursing Scholarship The Floyd Memorial Foundation Scholarship established this scholarship for students of Ivy Tech Southern Indiana having received matched funds from the Paul Ogle Foundation. The scholarship is held by the Community Foundation of Southern Indiana. Be accepted into the R.N. Program at Ivy Tech Community College Southern Indiana campus Have a GPA of 2.7 or higher on a 4.0 scale Have displayed commitment to the nursing profession Be currently employed at Floyd Memorial and indicate a desire to continuing working at Floyd Memorial Applicant must sign a scholastic loan agreement stating they will agree to work for Floyd Memorial for one year following graduation. If the individual does not fulfill their agreement, they must repay the scholarship based on the length of employment Financial need may be considered, but will not be the determining factor Selection Criteria: Selection will be made from applications of those qualified individuals who meet the established criteria set forth above. Selection criteria is subject to change by the Foundation, as necessary, to ensure adherence to state or federal laws. Floyd Memorial Foundation Marcella Miller Scholarship The Marcella Miller Scholarship Fund was established in 1994 after Marcella s death (an R.N. at Floyd Memorial Hospital and Health Services). Marcella exemplified the true picture of a nurse through her caring of patients, families and her wonderful sense of humor. Through contributions by the family and friends of Marcella Miller, R.N., who passed away that year, the scholarship continues today. Grants are awarded annually to a student who is pursuing the profession of a registered nurse. Be accepted into the RN Program at Ivy Tech Community College Southern Indiana campus Have a GPA of 2.7 or higher on a 4.0 scale Have displayed commitment to the nursing profession Be currently employed at Floyd Memorial and indicate a desire to continuing working at Floyd Memorial Sign a scholastic loan agreement stating they will agree to work for Floyd Memorial for one year following graduation, if the individual does not fulfill their agreement they must repay the scholarship based on the length of employment Financial need may be considered, but will not be the determining factor Selection Criteria: Selection will be made from applications of those qualified individuals who meet the established criteria set forth above. Selection criteria is subject to change by the Foundation, as necessary, to ensure adherence to state or federal laws. Ford/EEOC Endowed Scholarship This scholarship is made available through funds made available by the Ford Motor Company and held by the Ivy Tech Foundation. Scholarship may be granted to women and minorities only Preference will be given to Ford employees, their spouses and children. If you have this connection, please submit documentation from the appropriate Ford Motor Company personnel department showing employment and/or applicant s relationship to the employed individual Submit this documentation with the application Futures Unlimited Scholarship This scholarship is to help first time Ivy Tech Southern Indiana students achieve their educational goals and gain the skills needed to succeed in the workplace. Be a first time student at the Ivy Tech Community College Southern Indiana campus Have a financial need. A Free Application for Federal Student Aid (FAFSA) must be completed Preference will be given to displaced homemakers, displaced workers, minorities and recipients of public assistance. Assessment test scores or previous academic history at previous institutions may determine eligibility for the scholarship. Gerrit Langemaat Scholarship This scholarship available through the Ivy Tech Foundation was established in honor of Gerrit Langemaat. Langemaat, who died in 1993 after a sudden onset of cancer, was an instructor and Program Chair of the Computer Information System Program for ten years. Be a second year Ivy Tech Southern Indiana student or a 2011 graduating senior from North Harrison High School Have a financial need A Free Application for Federal Student Aid (FAFSA) must be completed Preference will be given to full time students 8204 Highway 311 Sellersburg, IN (812) , ext

7 Harrison County Hospital Foundation Scholarship The Harrison County Community Foundation holds this scholarship through a match from the Paul Ogle Foundation. This scholarship supports Harrison County residents enrolled in a college health related program. The Harrison County Hospital Foundation may provide recommendations on an annual basis. Be a Harrison County resident Be enrolled in a health care related program Harvey S. Poling, Jr. Scholarship This scholarship, held by the Ivy Tech Foundation, is established as a tribute to a veteran teacher and Ivy Tech Southern Indiana administrator, Harvey S. Poling, Jr. Be at least 28 years of age Have completed at least one-half of the program of study Have a financial need. A Free Application for Federal StudentAid (FAFSA) must be completed Homer B. Smith Scholarship This scholarship is available through the Ivy Tech Foundation and established by Homer B. Smith, longtime administrator of the Ivy Tech Southern Indiana campus. The Paul Ogle Foundation provided matching funds to the scholarship. Applicant must be a 2011 New Washington High School graduate Recommended 2.5 GPA on a 4.0 scale Ivy Tech Community College High School Scholarship There are eight scholarships available for high school seniors who will enroll as freshmen for the year. The scholarship will be for tuition up to 12 credit hours per semester (fall & spring semesters only). There is one scholarship available for a student from the Indiana counties of Clark, Crawford, Floyd, Harrison, Scott, Orange, and Washington. There is also one scholarship available to one student from either of the Kentucky counties of Jefferson, Oldham or Bullitt. Be a 2011 high school graduate Be accepted for enrollment at the college Minimum 3.0 GPA with preference of 3.5 GPA Demonstrated leadership potential SAT, ACT or ASSET/Compass test scores Be enrolled as a full-time student (12 credit hours or more) during both the fall & spring semesters May 2011 high school graduates must submit a copy of their high school transcript with application (five semester/through first senior semester) Ivy Tech Community College County Scholarships This scholarship is funded through the Ivy Tech Southern Indiana fee remission program. It will be for 12 credit hours tuition per semester (fall & spring only). There is one scholarship available from the following Indiana counties of Clark, Crawford, Floyd, Harrison, Scott, Orange, and Washington. There is also one scholarship available to one student from either of the Kentucky counties of Jefferson, Oldham or Bullitt. The College reserves the right to award funds to an eligible student from another county. Minimum 3.0 GPA with preference of 3.5 GPA in high school or a post secondary institution Demonstrated leadership potential SAT, ACT or ASSET/Compass test scores Be enrolled as a full-time student (12 credit hours or more) during both the fall & spring semesters Possess a GED score of 54 or higher (student must submit supporting documentation) Ivy Tech Community College/Prosser School of Technology Scholarship for Harrison County The Harrison County Community Foundation holds the Ivy Tech Community College/Prosser School of Technology scholarship through a match from the Paul Ogle Foundation. First priority is for residents of Harrison County who have attended Prosser School of Technology and have met the College admissions requirements Residents of Clark, Floyd or Washington counties may be considered if there are no applicants from Harrison County Prosser School of Technology transcript must be submitted with the scholarship application Jesse Ballew Family Scholarship The Community Foundation of Southern Indiana holds this scholarship fund through a match from the Paul Ogle Foundation. Preferences for this scholarship are high school seniors who meet the following: 1st preference is for students who are Graceland Baptist Church members, submit verification from the church with application 2nd preference is for students who have graduated from Christian Academy of Indiana 3rd preference is for students who have graduated from religious-based schools 4th preference is for high school graduates from Clark or Floyd Counties With a recommended 2.5 GPA on a 4.0 scale. 5

8 Ken Staley Scholarship This scholarship is available through the Ivy Tech Foundation and established to honor Ken Staley. Ken, who died in 1983 after a battle with cancer, was a dedicated Dean of Student and Instructional Affairs at Ivy Tech Southern Indiana. Preference given to students enrolled in Design Technology, Electronics and Computer Technology, or Manufacturing and Industrial Technology Must have a financial need A Free Application for Federal Student Aid (FAFSA) must be completed Legacy Award Scholarship This scholarship is designed to promote and recognize community service and civic engagement among Ivy Tech Southern Indiana students. The Ivy Tech Foundation will award two $500 Legacy Scholars scholarships in the fall and spring semesters. This award is renewable for the second year if the student maintains eligibility requirements. Accepted for enrollment or enrolled at Ivy Tech Southern Indiana Demonstrate a long term commitment to service and civic engagement Have a GPA of 3.0 or higher on 4.0 scale Be enrolled as a full-time student (12 credit hours or more) during both fall & spring semesters of the academic year Selection Criteria: A screening interview may be required to make a final selection as determined by the scholarship committee. Martha Hartstern Nursing Scholarship The scholarship is designed to provide scholarship assistance in the form of non-renewable grants for books to students who meet the criteria. The Community Foundation of Southern Indiana holds this scholarship fund through a match by Paul Ogle Foundation. Selection Criteria: Incoming, non-traditional students (those who did not enroll at Ivy Tech immediately following graduation from a secondary school) Accepted in the ASN program PNC Bank Scholarship The Harrison County Community Foundation holds this scholarship through a match from the Paul Ogle Foundation. This scholarship supports Harrison County residents enrolled in a college program. Be a Harrison County resident. Prosser School of Technology Scholarship This Prosser School of Technology scholarship held by the Community Foundation of Southern Indiana is made available by an anonymous donor and through a match by the Paul Ogle Foundation. Eligible students must have attended classes at Prosser School of Technology Recommended 3.0 GPA Prosser School of Technology transcript must be submitted with the scholarship application Regions Bank Scholarship This scholarship held by the Harrison County Community Foundation is made available through a matching grant from the Paul Ogle Foundation and a donation by Regions Bank. First priority is for residents of Harrison County Residents of Clark, Floyd, or Washington counties may be considered in the event Harrison County residents do not utilize the scholarship funds 6

9 Scott Memorial Hospital Scholarship Scott Memorial Hospital and a match by the Paul Ogle Foundation fund this scholarship held by the Scott County Community Foundation. First priority is for residents of Scott County Residents of Clark, Floyd, Harrison or Washington counties may be considered in the event there are no applicants from Scott County Applicant must already be enrolled in a program of study leading to a one-year Technical Certificate or the two-year Associate in Science Nursing Degree program; or taking courses to prepare for enrollment in such a program of study For students admitted to the Nursing programs, the applicable exam (NET/TEES or PSB tests) may be taken into consideration Women s Foundation of Southern IndianaScholarship This scholarship is for women desiring to continue, re-enter or attend college for the first time. The Women s Foundation of Southern Indiana is a non-profit organization established under the auspices of the Community Foundation of Southern Indiana. The scholarship is non-renewable. Female student at least 25 years of age A resident of Clark, Floyd or Harrison counties for one year Demonstrated financial need through submission of the FAFSA Selection: Applicants will be reviewed by the Scholarship Committee with final selection determined by the Foundation. For information on the Women s Foundation of Southern Indiana visit: Ivy Tech Community College Southern Indiana Scholarship Guide 7

10 Separate Scholarship Application Required Coca-Cola All-State Community College Academic Team Program Any student enrolled in the Fall Semester 2010 at Ivy Tech Community College in Sellersburg is encouraged to apply for each of these recognition programs with an application if they meet each of the following qualifications: Expects to be enrolled at this campus through December 2010 Currently posts a cumulative grade point average of 3.50 or higher for all coursework completed in the last five years Is on track to receive an Associate or Bachelor s Degree Will have at least 36 semester hours by December 31, (30 hours must have been earned within the past five years) Must have a community college record free of suspension, probation or other serious disciplinary action Our campus can nominate two students. Our two nominees will be entered into two national contests: the All-USA Community College Academic Team (the top 20 receive $2,500 and a medallion) and the Coca-Cola All-State Community College Academic Team (300 finalists will also receive between $1500 and $1000 stipends and medallions). The top scoring students in the State of Indiana will receive a New Century Scholars recognition including a $2000 stipend and a trip to Seattle, Washington where they will be recognized at the AACC Convention in April Each and every member will be ranked and placed on the Indiana First, Second or Third Team. Our two nominees will receive a medallion and can attend, with one guest, an awards luncheon in Indianapolis. All Indiana team members will be recognized in the Indianapolis Star. This is not a competition of knowledge. The All-USA/All- State Academic Teams are merit awards based on students community college accomplishments. The centerpiece of the nomination is the essay about the nominee s most outstanding community college endeavor. If you are interested in competing for the State and National teams, please see Twila in room G9 or the scholarship bulletin board for an initial application packet. Holmes Endowed Scholarship This is an endowed scholarship fund established in memory of Howard and Louise Holmes. Mr. and Mrs. Holmes valued education and emphasized its importance for all individuals - especially those without a family history of attending college. First-generation college student Degree declared student Completed at least one semester Financial need Enrolled in at least six credit hours Reference from employer or faculty member Separate Application Form: Ivy Tech Central office will randomly select up to three regions that will rotate from year-to-year thereafter. No one campus will be selected until each region has had the opportunity to participate in the award selection. The Holmes Endowed Scholarship has a separate application form. If you would like more information on this scholarship, please see for details contact (812) , extension Jeffersonville Urban Enterprise Zone Scholarship The Jeffersonville Urban Enterprise Association awards scholarships to individuals for pursuit of higher education. Eligibility will be based on the following criteria. Individuals must: Live or work in one of the two Jeffersonville Urban areas Be enrolled in one of the following schools: Indiana University Southeast or IU Bloomington, Ivy Tech Community College Southern Indiana, or Purdue University at New Albany All applications must be postmarked or receipt-stamped by the deadline (March 13, 2011) to: City of Jeffersonville Urban Enterprise Association Attn: Scholarship Committee Redevelopment Office 500 Quartermaster Court Jeffersonville IN For questions and scholarship application, contact Office of Redevelopment at (812) , [email protected] or web contact at 8

11 Application Process The completed application packet must be submitted by the deadline stated for each particular scholarship. If you are mailing the application, the postmark must be no later than the deadline date. Please read the criteria for each scholarship carefully as some require additional documentation. If the documentation required is not included, the application can not be considered. It is each student s responsibility to complete an application for EACH scholarship and submit supporting documentation. Documentation can be a high school transcript or unofficial college transcripts. ALL APPLICATIONS MUST HAVE AN UNOFFICIAL TRANSCRIPT ATTACHED. Each current Ivy Tech Southern Indiana student may obtain an unofficial transcript at To be eligible for any of the scholarships in this Guide, a student cannot be an undecided student. Office of Development will notify winners no later than the end of April, congratulating them on the scholarship awards and also providing information about the next steps in the process. Non-winners will not be contacted. AWARD AMOUNTS WILL BE AVAILABLE AT THE ORIENTATION HELD IN MID-JULY FOR ALL SCHOLARSHIP RECIPIENTS Please remember you MUST complete and submit one application for EACH scholarship you plan to pursue. (Please attach all of the required documentation to the application as well). Scholarship Checklist r Carefully review the information in this Guide. r Identify scholarships for which you are eligible and wish to apply. r Complete the Ivy Tech Southern Indiana Scholarship Application Form for EACH scholarship you are pursuing. r ATTACH A TRANSCRIPT. r Submit one completed application and any additional documentation required by the deadline date. Send to: Office of Development - Scholarships Ivy Tech Community College Southern Indiana 8204 Hwy 311 Sellersburg, IN (812) , extension 4212 r If a new student, please complete the admission process to Ivy Tech Southern Indiana. Please also include your submission of high school transcript and ASSET/COMPASS Test (or waiver) by application deadline. ( Note: If you have any questions about admissions, please contact the Office of Admission at (812) ext r Complete and submit your FAFSA ( if appropriate. 9

12 Scholarship Application ALL APPLICATIONS MUST INCLUDE TRANSCRIPT I am applying for the following scholarship(s): I am a (check one) r Current high school student, transcript through first senior semester with GPA attached. r New/transferring student, high school or college transcript with GPA attached r Current Ivy Tech Community College student, and have attached my college transcript(s) including GPA. APPLICATION DATA Name Ivy Tech Student C Number: (C Number will be on your Ivy Tech ID Card) County of Residence U.S. Citizen r Yes r No Telephone Number Cell Phone Home Address City, State, Zip Preferred address: Personal Data (Optional) Completion of this section is optional. However, responses are necessary to determine eligibility for certain scholarship programs. Please review the eligibility criteria and respond to questions related to the scholarship(s) for which you wish to be considered. Date of Birth Sex r Male r Female Race r African American r Asian r Caucasian r Hispanic r Native American r Other 21st Century Scholar r Yes r No Are you or an immediate family member employed by: Ford Motor Company r Yes r No Are you employed? r Yes r No If yes, where? High School Data (Current High School Student) High School Attended Graduation Date GPA SAT Scores Verbal Math ACT Scores English Math Composition College Data (Current/Transferring Student) Program of Study Graduation Date GPA Enrollment Status r Full-time (12+ hours) r Part-time (6+ hours) College Credit Hours Earned Make sure to complete the back side of this form

13 Scholarship Application ACTIVITIES List four major activities from your school, community, civic and/or church related activities in which you have participated without pay during the past five years (Please list no more than two athletic events). Supporting documentation with signature or reference letter will be required for proof of activities and hours. Activity Number of Hours Awards Please list any service, academic or vocational awards you have received during the last five years. Supporting documentation will be required (examples: certificates, letters, newspaper articles, etc.) for proof of award. Reference letter(s) Provide two reference letter(s). Examples: community leaders, instructors, church and employers (no family members). Short Essay Please type a short essay on one of the following two topics (One double spaced page:) Your educational goals and what you hope to accomplish by earning a degree. Why receiving a scholarship is important to you. The information I have submitted for this application is correct and complete to the best of my knowledge. I give permission for Ivy Tech Community College Southern Indiana to release information to its selection committees so I may be considered for scholarships and awards. If I am offered a scholarship or an award, Ivy Tech Community College Southern Indiana has my permission to use my name and non-confidential information such as my residence, high school, and name of award in any promotional material. r Yes r No Signature Date PLEASE REMEMBER TO COMPLETE ONE APPLICATION FORM FOR EACH SCHOLARSHIP Ivy Tech Community College Southern Indiana 8204 Highway 311 Sellersburg, IN (812) , extension

14 SCHOLARSHIP GUIDE Changing Lives. Building Futures. The Ivy Tech Southern Indiana campus expansion; inspired by the past in service of the future. Ivy Tech Comunity College Southern Indiana 8204 Highway 311 Sellersburg, IN (812)