Howard Taylor Batman Scholarship Application Submission Deadline: March 10, 2016, 12:00 midnight EST Applicant must be an Indiana high school senior from Vigo County or Crawford County who plans to attend Indiana University Bloomington as a full-time student. GENERAL Name Last First Middle University ID Number Home Address Street City State Zip Phone Number Email Birth Date I plan to attend Indiana University as a full-time student: Yes No Name of High School GPA SAT and/or ACT Please list your extracurricular activities and interests: Father s Name (or legal guardian) Age Occupation Father s Education: High School College Degree Mother s Name (or legal guardian) Age Occupation Mother s Education: High School College Degree Parent(s ) Annual Income $ I will be requesting aid from Indiana University: Yes No To assist in the evaluation of financial need, you must complete the FAFSA (Free Application for Federal Student Aid) form. *Applicants may attach an additional sheet (with name included) indicating special financial circumstances. Number of Brothers Ages Sisters Ages
Page 2 Please write a brief essay on each of the following topics: ESSAY 1. Describe individuals and/or events that have influenced your consideration of careers and/or course of study. (Please attach a separate sheet and include your name.) 2. How do you think you can best serve your community in the career you now anticipate? (Please attach a separate sheet and include your name.) 3. Provide a statement of your ambition and goals in relation to your planned course of study. (Please attach a separate sheet and include your name.) REFERENCES Two references are REQUIRED. One must be from outside the school setting. One must be from inside the school setting. Please be sure your references use the forms provided. Name Inside School Setting Outside School Setting Name Inside School Setting Outside School Setting Signature Date The deadline for submitting this application is March 10, 2016, 12:00 midnight EST. Applicants will be selected and the recipients will be announced prior to graduation. PLEASE RETURN THIS HOWARD TAYLOR BATMAN SCHOLARSHIP APPLICATION TO YOUR SCHOOL COUNSELOR FOR COMPLETION.
Page 3 Reference Sheet and Questionnaire 1 Two references are REQUIRED. One must be from a high school teacher well acquainted with the student s academic strengths and should focus on the student s academic abilities. The second reference must be from outside the school setting. Student Name Name Date Relationship to Applicant Please call for additional information Phone References are due March 10 and may be mailed directly to:
Page 4 Reference Sheet and Questionnaire 2 Two references are REQUIRED. One must be from a high school teacher well acquainted with the student s academic strengths and should focus on the student s academic abilities. The second reference must be from outside the school setting. Student Name Name Date Relationship to Applicant Please call for additional information Phone References are due March 10 and may be mailed directly to:
Page 5 To be completed by high school principal or counselor Your recommendation is an important factor in the application process. Information provided will be held confidential. Applicant Name Applicant s rank in class Size of class Basis for rank: Seniors College Prep Applicant s GPA (on a 4.0 scale) SAT Verbal Math ACT Type of high school: College preparatory General Vocational Additional comments: I do not know this student well enough to comment. I recommend this student for the Howard Taylor Batman Scholarship. Please call for additional information Signature Date Written Name Title School Address Street City State Zip Please enclose a transcript of grades with the application and mail by March 10, 2016, 12:00 midnight EST to: