THE ETTA BLANCHE SMITHDAHLGREN SCHOLARSHIP This scholarship is made available by interest from a generous gift given to Central Heights High School by the Etta Blanche Smith-Dahlgren estate in 2004. Central Heights was named because she was a graduate of Richmond High School and she wished to remember her school. She always had a high respect for the rural communities of Kansas and expressed this in several ways. Giving back to her high school, now Central Heights, was one of the ways. Mrs. Smith-Dahlgren was born just southwest of Richmond on the farm homesteaded by her grandparents in 1873. When county lines were drawn, the family’s home was in Anderson County and the barns in Franklin County. (None of the original buildings is still standing). Following graduation from Richmond High School, she taught at one-room schools for a few years and began taking college summer courses. She then taught at Richmond and other grade schools and ended her career as principal of Frances Willard Elementary School in Kansas City. She earned a BSE from Emporia State University and a Master’s in education from Columbia University, New York. Mrs. Smith-Dahlgren was named Kansas Teacher of the Year in 1963 and was inducted into the Kansas Teachers Hall of Fame at Dodge City. After 45 years as an educator, she retired and began a second career representing the Kansas Retired Teachers Association, Association of Retired Persons (AARP), and similar organizations for several years, working in the legislative area for quality of life and improved conditions for all Kansans. Looking for a way to take information about agriculture to young people and wanting to honor their parents and grandparents, she and her late sister, Kathryn Smith-Wilcox, gave leadership and funds to provide the Smith Farm House at the Kansas Agricultural Hall of Fame near Bonner Springs. The house, very similar to the old Smith home near Richmond, was dedicated in 1996 and is an important teaching tool at the national center. In 2003, the Smith Event Barn, also provided by the sisters, was added at the Ag Hall of Fame complex, giving the center a year-round activities/meeting area which is used often by school groups. Her estate was bestowed upon a dozen schools, churches, historical societies, the Ag Hall of Fame, National Teachers Hall of Fame Foundation ad a health advocacy group. The amount received by Central Heights School was one of the larger amounts specified in her estate. Only the interest will be used for scholarships so the entire gift will be with Central Heights forever. Mrs. Smith-Dahlgren was a woman who loved, respected and appreciated her agricultural roots and upbringing. She wanted to share with others the zeal and dedication for learning, as well as an excellent work ethic she believed she gained from growing up in rural Kansas with hard-working, Christian parents. Recognizing young people with scholarships is her way of doing this.
Etta Blanche Smith-Dahlgren Scholarship Application
“We cannot hold a torch to light another’s path without brightening our own”. Ben Sweetland (Click on the grey box and begin typing requested information) Name: Last First
Address: Where to you plan to continue your education? What will your major or concentration be? Why do you need a post-secondary education?
What is your Cumulative Grade Point Average?
ACT composite score
Describe your strongest character trait:
List Activities/Clubs to which you belong (be sure to include offices held):
Directions for including additional documentation: Include your name and address in the heading on each document. Give each essay or list an appropriate title Do check spelling and proof-read each document Include any additional documents with this application page. We are particularly interested in community involvement activities; you may include newspaper clippings, letters of recommendation, etc.
Submit Completed Applications to your counselor by April 1, 2017 Applicants will be given a time for an interview with school personnel for this scholarship.
Franklin County Farm Bureau Association 103 E. First - P.O. Box 777 Ottawa Kansas 66067
[email protected]
Spring 2017
Dear Franklin County High School Senior, Graduation is soon approaching, and with that comes the filling out of many applications for scholarships! The Franklin County Farm Bureau Association would like to invite you to apply for one of four $500 scholarships being offered by the association to Franklin County seniors whose parents are Farm Bureau members and who are planning to attend a two- or four-year college or technical school. This year our scholarships can be used at an out of state school, as well! As in prior years, two of the scholarships are based on academic achievement and will be heavily weighted on scholastic performance, extracurriculars, and community involvement. To apply for this scholarship, carefully complete the next two following pages. The Franklin County Farm Bureau also realizes that our roots are in agriculture. One in five Kansas jobs – even in urban areas – are still directly related back to agriculture today. The future of agriculture rests on the shoulders of youth who embrace it…members of the FFA and 4-H. To recognize the efforts of FFA and 4-H members, our association is offering two scholarships that will be heavily weighted towards performance in either or both FFA and 4-H. To apply for this scholarship, carefully complete all three of the following pages. Feel free to apply for both. On behalf of the Franklin County Farm Bureau Association, good luck! Allen Campbell
Allen Campbell President Franklin County Farm Bureau Assn.
FRANKLIN COUNTY FARM BUREAU ASSOCIATION 2017 SCHOLARSHIP APPLICATION Full Name
______________________________________________________
Address
______________________________________________________
City
______________
State KS
Zip ____________
Graduate of Central Heights High School
Parent/Guardian
_________________________________________________
Parent/Guardian Farm Bureau Membership #: ___________________________ Address:
______________________________________________________ City
______________
State ______
66 Zip ____________
Occupation _______________________________________________________ Business Address
_________________________________________________
City ______________
State _________
Zip ____________
Which scholarship(s) are you applying for? (Check One or Both) _______
Scholarship Honoring Academic Accomplishment
(Two Awarded)
_______
Scholarship Honoring FFA and/or 4-H Membership
(Two Awarded)
REQUIREMENTS 1. A current photograph with ID on back (for publicity purposes) 2. Two letters of recommendation - one from school and one from community (example: employer, pastor, 4-H leader) 3. If applying for FFA/4-H Scholarship: Typed statement from Advisor and/or Club Leader. (no immediate relatives) 4. A copy of your transcript and ACT score 5. Parent/Guardian must be Franklin County Farm Bureau members 6. Must be attending a Two- or Four-Year College or Technical School 7. Neatly completed application must be submitted by April 1, 2017 8. Return to: Franklin County Farm Bureau Association P.O. Box 777, Ottawa, KS 66067
2017 Franklin County Farm Bureau – Scholarship Application **Complete this page for either scholarship!** College/Tech School of your choice ____________________________________ Intended Major or Program of Study ___________________________________ Other Scholarships _________________________________________________ _________________________________________________________________
Leadership - List activities and any positions held on the following: Community Service _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Honors/Awards _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Extracurricular Activities _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Are you currently employed? ________ By whom? _______________________ Employer’s address__________________________________________________ 4-year GPA? _____ ACT score? _____ Class Rank _____ out of _____ students. In 50 words or less describe why you should be considered for this scholarship, excluding above information: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
2017 Franklin County Farm Bureau – Scholarship Application
FFA/4-H SCHOLARSHIP (This additional page MUST be completed if applying for the FFA/4-H Scholarship.)
***Include a written statement from your Advisor/Club Leader. (Non-relative)***
Career and Personal Development Attach an essay describing your major 4-H Project(s) and/or FFA Supervised Agricultural Experience Program (SAE’s) and share with the committee what you have learned/gained from these experiences. (Typed, one page maximum.)
Judging Teams/Career Development Events – List participation and high placings _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Leadership – List major leadership positions/offices/committee chairs/etc. _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Trips/Other Leadership Development Experiences – List any conferences attended or any other experiences you have had through FFA and/or 4-H.
_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
2017 Friends of FFA & Don Davis Memorial Scholarship Application (revised Nov. 2015)
Return to Mrs. Allen by April 14, 2017
Eligibility Requirements: *Senior who has been involved with the Central Heights FFA Chapter for a minimum of two (2) years.
Instructions: *Fully complete a typed application *Submit one (1) written reference from an individual who is not a teacher and is non-related. (example-employer, club leader, clergy, etc.) *Complete a typed essay addressing “How FFA has impacted me and what is the most positive contribution I have made or done for Central Heights FFA chapter”. (Maximum 1 page) *Provide a typed summary of ONLY FFA leadership, community service, participation and recognition/honors. (Maximum 1 page. May use bullets, lists, or tables.) Start with the most recent accomplishments in each area. Provide year(s) of participation.
: Complete the following information:
Applicant Name: __________________________________________________
Address: _________________________________________________________ _________________________________________________________________ What is your intended college/vo-tech major? _________________________________________________________________ _________________________________________________________________ What school do you plan to attend and why?___________________________ _________________________________________________________________ Current G. P. A.: ________________
Years in Central Heights FFA:____________________
Has your parent/guardian volunteered to help Friends of the FFA in any way? ___________________ If so, please list their involvement: ____________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___________________________________________________________________ ** Don’t forget to submit a letter of reference, essay and activity summary!
Scholarship Score Sheet This form is used for the scholarship selection committee – you do not need to print this – it is just for your information. Scholarship Applicant Assigned Number:___________________ Please review applications and award points up to the amount listed in each category: Parent, guardian or representative is a current paid member of Friends of FFA. (10 pts.) _________ Parent, guardian or representative is an active member of Friends of FFA. (up to 15 points) __________ Applicant is in good academic standing with CHS and is eligible to graduate. (10 points) Involved in FFA:
2 years
( 5 points)
3 years
(10 points)
4 years
(15 points)
___________
____________
Leadership (up to 10 points)
____________
Community Service (up to 15 points)
____________
Participation (up to 20 points)
____________
Recognition/Honors (up to 5)
____________
Total Points Awarded (possible of 100):
____________
SCORING SHEET 90-100 points
$1,000.00
80-89 points
$750.00
70-79 points
$500.00
60-69 points
$250.00
An additional $100 will be given to a selected applicant chosen by the Davis family as the winner of the Don Davis Memorial Scholarship. After retiring, Don was an active farmer/rancher in the Rantoul area. He was a strong supporter of the Central Heights FFA. Don passed away in June of 2014 and a scholarship was set up in his memory.
Franklin Country Friends of
Kansas State University Scholarship Application
Selection of scholarship recipients is by the discretion of Franklin County Friends of K-State scholarship committee. Considerations include, but are not limited to, academic achievement, extra-curricular activities, financial need, education goals, and completeness of the scholarship application. To facilitate application completion, the application is being provided in electronic form. Please keep the application to 4 pages plus transcript and reference letters. Please provide responses where indicated by underscore characters ( __ ), removing the underscore characters.
Name: __ Social Security #: High School: Home Address: __ City, State, Zip: __ Phone Number: __ Parent’s Names: __
__ __
Student’s Signature: ________________________________________________
Principal’s Signature: _______________________________________________
Parent’s Signature: _________________________________________________
Academic Achievements:
A. College Entrance Examination Scores ACT: __ SAT: __ B. Student Cumulative High School Grade Point Average (GPA): __ C. Class Rank and Size Rank: __ Size: __ D. Include a copy of High School Transcript with the scholarship application E. Planned major at Kansas State University: __ F. Include 2 reference letters. Only one reference letter may be from a school official (Principal, teacher, coach associated with the school, etc.) and neither reference letter may be provided by an immediate family member.
Name: __ SSN: __
Financial Need: A. Your family’s Adjusted Gross Income from last year’s Federal Income Tax form: Adjusted Gross Income (rounded to nearest $5000): __ B. For the 2016/2017 school year, the number of family members including yourself: Living at home: __ Attending an institute of higher education: __ C. Employment Information Current place of employment: __ How many hours per week are you working: __ How many years have you had current job: __ Previous place of employment: __ D. Please list any other scholarships you have been awarded and those for which you have applied. Include the dollar amount if known: ● Franklin Co. Friends of K-State – scholarship not yet awarded – amount unknown ● __ E. Detail other financial considerations to be noted by the selection committee (please limit to 300 words): __
Name: __ SSN: __
Extra-Curricular Activities: A. List club memberships (indicate years involved) and offices held (indicate year offices held) ● __ B: List honors and awards received (indicate year received) ● __ C: List community services involvement (indicate years involved and amount of time spent each year performing the specified community service) ● __
Name: __ SSN: __
Educational Plans/Professional Goals: In 400 words or less, please explain why you chose your specified major and your professional goals. __
Provide, in 250 words or less, a description of why you should be the recipient of a Friends of K-State Scholarship and why you have chosen to attend Kansas State University. __
All applications must be post marked by April 1, 2017
Franklin Country Friends of
Kansas State University Scholarship Application
Instruction Sheet The Franklin County Friends of K-State scholarships are awarded to high school seniors in Franklin County attending Kansas State University; the scholarships may not be used at other institutes of higher education. The number of recipients and amount of scholarships provided are by discretion of the Franklin County Friends of K-State Scholarship Committee. Information provided by applicants will be held in confidence and used for the sole purpose of recipient selection. To apply for the Franklin County Friends of K-State Scholarship: ● Download the application by visiting the: Franklin County Friends of K-State Facebook Page ● The application is limited to 4 pages plus the transcript and reference letters. ● Send completed application to
[email protected] or to the following address: Brad & Morgan Mathews Scholarship Chairpersons 1740 S. Willow St. Ottawa, KS 66067
Please submit any questions to
[email protected]
Applications must be postmarked by April 1, 2017 to be considered!
Giving Back Scholarship Return to your high school counselor by April 1, 2017 Type in requested information:
Name: Address: (street)
(town/city)
(state)
(zip)
College you plan to attend: (You must attend an in-state junior college, college or university to be eligible for this scholarship)
Anticipated area of study Short essays: Write a short essay about why you need this scholarship: How have you given to the school and to your community? How will you “Give Back” to the community if you receive this scholarship?
Lane Ruritan Scholarship Return completed application to your counselor by April 1, 2017 Save document on to your computer (Click on grey text box and begin typing requested response) Name: College you plan to attend: What will be your college major? ACT score: Cumulative GPA: (ACT scores and GPA will be on your high school transcript)
High School Activities and Leadership:
Community Activities: Write a paragraph on “Why you feel you deserve the Ruritan Scholarship” (attach additional page if necessary)
Lloyd Burkdoll Memorial Scholarship Save the document to your computer, type in requested information Name: (Last, First):
Address: (include city and zip code): What is your college/junior college/technical school major? What college/school do you plan to attend? Cumulative G.P.A.:
Class Rank:
Current GPA (this semester):
Number of Years at CH:
High School Activities and Leadership: (list all) Honors and Awards: (list all) Community Activities: (list all)
***Attach a short essay on what you feel your most important contribution has been to your school and your community.
(Return completed scholarship application to the Counseling Office by April 1, 2017)
Union Chapter 15, Order of the Eastern Star, Scholarship Applications are now being accepted for the Union Chapter 15, Order of the Eastern Star, Scholarship in the amount of $300 to be awarded to a Franklin County High School graduating senior who will be attending an accredited college or vocational school beginning with the Fall 2017 semester. It is our intent for this scholarship to be used toward the cost of tuition books or housing. If your application is chosen, the funds will be deposited in your name with the financial department of the college or vocational school where you are enrolled. The recipient of this scholarship will be notified by mail. This scholarship is open to all students; no affiliation with an Eastern Star or Mason is required. Submit your scholarship packet by March 30, 2017 to: ATTN: Union Chapter 15, OES, Scholarship Kay Towner 533 Elm
Or submit application to Mrs. Allen at Central Heights High
School Ottawa, KS 66067 Full Name: Home Address: City/ State/Zip: Day Phone #:
Cell Phone#:
Email Address: Are you currently enrolled and attending Baldwin High School? Yes ____
No_____
Current Grade Point Average : Name of college or vocational school you will be attending. Please include the address and phone number of the admissions or financial department:
What do you plan to major in?
Please attach to this application: 1. A transcript of your high school grades 2. A brief essay about yourself and your educational goals. Describe the activities you have participated in within your school and community, especially those pertinent to your proposed college major. After completing this application, have your high school counselor or principal sign to validate your information
To the best of my knowledge, the information given by the above-named student is true and correct. _______________________________________________________________________ Signature of school counselor or principal and Date
Scholarship Application Return completed application to your counselor by April 1, 2017 Save document on to your computer and type in requested information. Applicant Information Name: Phone: Address: City:
State:
Zip Code:
Parent(s) or Guardian(s) Names:
Post Secondary School Information Name and City of Institution You Attend/Plan to Attend: Major(s) Field of Study:
Minor(s) Field of Study (if any):
High School Information School Name and Address: Central Heights High School 3521 Ellis Road, Richmond, KS 66080 Cumulative GPA: List your High School Activities and years participated:
Leadership Positions and Awards (at school or in the community: .
.
List Community Activities you have been involved in :
Job(s) Held:
PEPSI SCHOLARSHIP Return completed application to your counselor by April 1, 2017 Save the document on your computer (type in requested information)
Name: G.P.A. (grade point average, cumulative): ACT Score: Your plans after high school graduation: (include school you plan to attend and major subject area and how you will use this training/education) List school and community activities in which you have been involved. Include any offices held: List honors or awards you have received: Applicants will be given a time to interview with school personnel during the first week in May.
RODNEY WHITE CHILDRENS FOUNDATION PO BOX 475 OTTAWA, KANSAS 66067
Scholarship Application Form Copy the scholarship on to your computer, delete lines and type in your information.
Personal Information Name: ___________________________________DOB:________________________ Address: ______________________________________ Phone: _________________ High School: ______________________________________GPA:________________ Senior Year: Absences:__________________ Tardies:____________________ College Planned: ______________________________Enrollment Date:_____________ What is your study interest: _________________________________________________ What are your goals: ______________________________________________________ ________________________________________________________________________ ________________________________________________________________________ What have you done in your lifetime to help and/or support children:__________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Did any of these children have special needs or medical issues? Y_____ N_____ If so, please explain: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Past Work Experience: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Activities Involved In/Awards/Titles Held(inside & outside of school/years involved): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Community Service Work? Y_____ N_____ Please explain: ____________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Family Information Parents/Guardian Information: (Name, Address, Phone Number) _________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________ _ PLEASE ATTACH A COPY OF HIGH SCHOOL TRANSCRIPT Additional Information Please enclose three letters of reference. One should be from a teacher or counselor, one from a friend, and one from a business associate or employer. Applications should be mailed to: The Rodney White Children’s Foundation PO Box 475 Ottawa, Kansas 66067 (If submitted to Mrs. Allen by March 30, she will mail your application for you) I will use this scholarship for the payment of tuition, room, board, books, or educational materials as may be required. I will be a full time student in a trade school, junior college, college, or university. The foregoing information and associated enclosures are true and correct to the best of my knowledge. Signed: ____________________________________ Application due April 1
The Charlene Faringer Trust P.E.O. Scholarship P.E.O. Chapter GL, of Ottawa, is offering our Charlene Faringer Trust Scholarship. The amount of the scholarship is $500. P.E.O. is an international philanthropic educational organization with over 5,800 chapters in the United States and Canada. You may apply for this scholarship if you are a female that will be attending an undergraduate course of study in the fall of 2016 at an accredited 2 or 4 year college, university or vocational-technical school. First preference will be given to a student planning to attend Cottey College in Nevada, Missouri. The application deadline is April 1, 2017. If you have any questions, call Linda Hemreck at 785-229-6729. Please mail completed applications to Linda Hemreck, 1531 Apple Lane, Ottawa, KS 66067 or turn in to your guidance counselor by April 1st. Please include official transcript and recent photo of yourself. Name: Address:
City, State, Zip:
Phone #:
Date of Birth:
High School: Central Heights High School
Yr. of Graduation 2017 Class Rank/# in class:
G.P.A.: Name of school you plan to attend in the fall of 2017: Location (City, State): _____ 4 yr. College or University
_____Vocational-Technical School
_____2 yr. Communitiy or Jr. College
_____Other…..please specify
Anticipated year of graduation______
Major course of study:
Father/Guardian Information:
Mother/Guardian Information:
Name:
Name:
Address:
Address:
Employer Name:
Employer Name:
Employer Location:
Employer Location:
Job Title:
Job Title:
Number of siblings attending post secondary schools for the 2016-2017 school year:
The Charlene Faringer Trust P.E.O. Scholarship cont. Please state other means that you have to subsidize your educational expenses, i.e., grants, scholarships, family benefits through University affiliation, educational trusts, student loans, etc.
List all school activities in which you have participated during the past 4 years. Indicate all special awards and honors. List all leadership positions and offices held. Use additional sheet if necessary.
List all community and volunteer activities you have participated in (without pay) during the past 4 years. Indicate all leadership positions and offices held. Use additional sheet if necessary.
In a couple sentences please tell us your goals for your future.
Applicant’s Signature _____________________________________ Date _________________
David Hull Memorial Scholarship Return completed application to your counselor by April 1, 2017. Counselor will attach a seventh semester transcript which includes ACT scores (if you have taken the ACT) and will forward application and transcript to the selection committee .
I.
PERSONAL INFORMATION (please type) A. Name
(Last)
(First)
(Middle)
Permanent Address Age
Birthplace
Phone
B. Name of Parent or Guardian (Last)
(First)
(Middle)
Permanent Address Occupation of Parent or Guardian C. Number of siblings II.
Ages of siblings
EDUCATION A. Month and year of High School Graduation B. Field of Major Interest C. College or Vo-Tech of choice D. Class Rank
III.
Class size
G.P.A.
ACTIVITIES AND HONORS A. List in order of importance to you, extracurricular and community activities in which you have participated. (Use back of page if necessary). B. List honors and awards (not scholarships) that you have received C.
If you have received or will receive other scholarships, indicate the name, amount and agency granting it. $
(amount)
$
(amount)
Name of Scholarship Name of Scholarship
$
(amount)
Name of Scholarship
1
IV.
List any kind of employment in which you have been engaged and your position held.
IV.
State, in your own words, why you believe you should be considered for the David Hull Memorial Scholarship
V.
Provide two letters of recommendation …one from a teacher or administrator (except counselor) and one from someone in the community. Letters of recommendation may be given to the applicant to submit or may be sent to the counselor’s office at USD 288, Richmond, KS 66080 to arrive no later than April 1, 2017.
2
Instructions for Kansas County Clerks Election Officials Association Scholarship Application (Fillable Form) Please complete all pages of the application with one of the enclosed forms, and an additional page with your essay. The scholarship is available to applicants who will be attending a Kansas College or University. It is important that all pages be emailed to the Ellis County Clerk, Donna J. Maskus:
[email protected]. Pertaining to the letters of reference, please note – when the applications are emailed without the letters of reference included in the packet some notice should be included that the letters of reference will be coming at a later date. All applications including essay, transcripts and letters are due on/or before April 3rd electronically, or postmarked by April 3rd if mailed. You may deliver to your County Clerk/Election Official by the due date; it will be forwarded to the Scholarship Chairperson; or you may mail or email directly to the Ellis County Clerk at PO Box 720, Hays, KS 67601. The $500 Scholarship winners will be announced at the KCCEOA May meeting. After a copy of the College Class Notification is mailed to the KCCEOA Treasurer, the funds will be sent to the Applicant’s College for the fall semester of the current year. The Local County Clerk/Election Official will contact the scholarship winners in each respective County. This notification should happen by May 15th each year. Thank You for Your Application For questions, you may call: Chair, Donna J. Maskus @ 785-628-9410 or email
[email protected].
Kansas County Clerks and Election Officials Association Scholarship Application (Fillable Form) The following requirements must be met to be eligible for this scholarship. Check boxes that apply 1. Major: Journalism☐/Political Science☐/Business☐/Communications☐ 2. Present Status: High School Senior ☐/College Freshman ☐/College Sophomore ☐ 3. Do you have a GPA of 3.0 or higher Yes ☐ No ☐ Personal Information Last Name: _________________________ First Name: ____________________MI:__________ Address: _____________________________________________________________________ Address
City
County
State
Zip
Email: _______________________________________ Date of Birth: _____________________________
Phone Number(s): ______________________________________________________________ Present High School or College Attending:
City and State of School:
School Year:
________________________________________________________________________________ College Planning to Attend:
City and State of School:
School Year:
________________________________________________________________________________ List additional educational courses or colleges attended:
Name of School, Graduation Date, College Hours, and Grade Average
Financial Information Give a brief explanation of source and amount of funds available for the academic school year in which this scholarship is requested:
Where do you plan to live while in school (please check one): Parents ☐/Relatives☐/Self Spouse ☐/Roommate ☐/Dorm ☐/Other ☐ Additional Requirements 1. A brief essay explaining your goals for your chosen career. Please limit it to one page. 2. Official High School and/or College Transcripts for each school attended. If the school or college is mailing them, please note when sending your application. 3. Two letters of reference: one should be from a friend or relative and the other from a business associate, past employer or teacher. 4. Application must be received by April 3rd to: Chairperson: Donna J. Maskus, Ellis County Clerk, PO Box 720, Hays, KS 67601. You may turn the application into your local County Clerk/Election Official, and it will be forwarded in a timely manner.
List participation in school activities:
List community service participation:
List honors or awards received:
Family Information Father’s or Guardian’s Name: _______________________________________________________ Address: ________________________________________________________________________ Occupation: _____________________________________ County Employee
Yes☐ No ☐
Mother’s or Guardian’s Name: _______________________________________________________ Address: ________________________________________________________________________ Occupation: _____________________________________ County Employee
Yes☐ No ☐
Please list the name and ages of all siblings/children, and how many are in college or other postsecondary education:
Thank you for your interest in the Kansas County Clerks Election Officials Scholarship process I certify that the foregoing statement and enclosures are true and correct to the best of my knowledge. _________________________________________________________________________________ Date Typed Signature of Applicant Please include your typed or written essay explaining your goals for your chosen career on one separate 8 ½ x 11 sheet.
High School Academic Year 2012-2018
Deadline: March 31st
Janice M. Scott Memorial Scholarship Fund Application You are to submit all documentation to The Janice M. Scott Memorial Scholarship Fund, ATTN: Mr. Abraham Scott, Post Office Box 1023, Springfield, Virginia 22151 I,
have read and understand the requirements of the Janice M. Scott
Scholarship Fund application submission process. I authorize school personnel of my high school to release transcripts of my academic record and other information requested for consideration by the Janice M. Scott Memorial Scholarship Fund Scholarship Selection Committee. I understand that this application will be made available only to qualified individuals who need to see it in the course of their duties. I waive the right to access any sealed prepared and/or written documents in support of my application submission process. If selected for a scholarship, I agree to allow my photo and mini-BIO be posted on the Janice M. Scott Memorial Scholarship Fund’s website. I also affirm the information contained herein is true and accurate to the best of my knowledge and belief.
Date
_________________
Signature
___________________________________________ *
Legal name in full (Print/Type)
Last Name
Address of Permanent residence
First Name
M.I.
Number, Street, and Apartment Number
City
Name of your High School
State
ZIP
State
ZIP
School Name
Address of High School Address
African American Caucasian Hispanic Asian
Other
Home telephone: (
)
School telephone: (
)
E-mail address:
Class Rank: Number ______ out of a total of _____ Seniors
Age
Date of birth Month/Day/Year
(Check one) I am a
US citizen
Current cumulative GPA
Permanent resident
Resident alien expecting citizenship by the date of award
On a scale of
Number of member(s) in household__________. Number of member(s) in household who will be attending college during the fall semester__________.
Name: 1. List high school activities (student government, sports, publications, school sponsored community service programs, student-faculty committees, arts, music, etc.) List in descending order of significance. High School Activities
Dates
Offices
2. List public service and community or civic activities (homeless services, environmental protection/conservation, advocacy activities, work with religious organizations, etc). Do not repeat items listed previously. List in descending order of significance. Activities/type Of work
Role/employer
Application – page 2 of 3
Dates
# of Weeks Active/Average number of hours or weeks
3. List part-time/full-time jobs, non-government interns, and government activities (internships with government agencies, partisan political activities, ROTC, municipal boards, and commissions). List student government under item
4. List awards, scholarships, publications or special recognitions that you have received. List in descending order of significance.
Application – page 3 of 3
Date Janice M. Scott Memorial Scholarship Fund Post Office Box 1023 Springfield, Virginia 22151
District Office or High School Dear Sir/Madam, The Janice M. Scott Memorial Scholarship Fund or Fund was established in October 2001 by family members of the late Janice Marie Scott to honor her legacy as an advocator for youth and a supporter of community services within the Greater Metropolitan Area of Washington, DC. Mrs. Scott was among the 125 individuals who perished in Pentagon on September 11, 2001 when terrorists crashed American Airlines Flight 77 into that building. As we prepare to observe the 12th year of this tragic event. I am take great pleasure to announce that the Fund has awarded $260,950 in scholarships to 101 recipients since its inception. This milestone could not have been achieved without the staff disseminating timely guidance each year to the district offices and high schools within the fifty states and the District of Columbia. This repetitive action will no longer occur after this high school academic year of 2013/2014 unless a change or changes should occur in the program. Modifications have been made to the enclosed application and criteria sheet which will allow continuous use of these documents. The number of scholarships will range each year from three to six scholarships. The amount of the scholarships will be $2,500. They will be issued on a one-time basis and sent directly to the institutions for deposit to the student accounts of the recipients. The scholarship selection committee will continue to use “Need” category as a primary means for selecting recipients of scholarships. Need is one of the four categories used in the evaluation process of the application packets. This category has assigned forty percent of the points used to score the application packets. The primary evaluation document for this category is the financial aid document (FAD) as defined in the enclosed criteria sheet. I would like to point-out one major change to FAD requirement. Adjusted gross income (AGI) of a single parent or both parents previously could not exceed $100,000. This amount has been reduced from $100,000 to $60,000. High school seniors who want to apply must first determine whether they meet all the requirements as specified in the enclosed documents. Once determined they are met, they must complete and submit the enclosed application along with the other required documents as specified on the enclosed criteria sheet. Both the application and required
documents or scholarship packet must be received or postmarked on or before the deadline date of March 31st. Scholarship packets should be mailed to the following address: Janice M. Scott Memorial Scholarship Fund, ATTN: Abraham Scott, Post Office Box 1023, Springfield, Virginia 22151. Do not hesitate to call or e-mail me with any questions. My cell phone number is (703) 981-0535 (do not disseminate this telephone number to applicants or parents). The email address is
[email protected]. Thank you. Sincerely,
Abraham Scott Chairman, Board of Directors Janice M. Scott Memorial Scholarship Fund 2 encls
Janice M. Scott Memorial Scholarship Fund (JMSMSF) Criteria Sheet I.
Qualification/Eligibility
a. US Citizen or permanent resident of US b. GPA of 3.0/equivalent or higher (out of a 4.0 scale) c. High School Senior who will matriculate full-time at a US accredited four-year college or university within the fifty states or District of Columbia. d. Have demonstrated leadership abilities through participating in community services or other extra curricular activities. e. Combined adjusted income of the parents cannot exceed $60,000. II.
Required Documentation
a. Application- Each candidate must submit a complete and timely application. An application will be considered incomplete and not processed if all instructions have not been followed or the material presented is insufficient to permit an adequate review. Do not send supplemental or corrected material after the deadline date. Applications must be typed or completed with the use of a black/blue writing ink pen. The staff of the JMSMSF will not accept any application packet or portion thereof that is filled out with a pencil. Application and required documents should be neat and easy to read. Materials should be impeccable in terms of appearance and legibility. Mail the complete application packet so that it is received or postmarked on or before the deadline date of March 31st. Application packet should be mailed to: Janice M. Scott Memorial Scholarship Fund ATTN: Abraham Scott Post Office Box 1023 Springfield, Virginia 22151 b. Official Transcript- An official copy of the applicant’s high school transcript provided by the high school staff in a sealed envelope must be included in the application packet. Submission of an application along with the required documents for this scholarship constitutes your authorization for the JMSMSF Scholarship Selection Committee to review your academic record. c. Letters of Recommendation – Each packet must include two letters of recommendation (LOR). One of the letters must be from a faculty member who has taught the applicant in the classroom. Each LOR must include the reference’s name, address, telephone number, and information regarding how long and in what capacity he or she has known the applicant. d. Financial Document – The submission packet must include a copy of the applicant’s Student Aid Report from the Department of Education or FAFSA. If none of these reports are not available, the applicant can submit a copy of the parent’s income tax return (Submit only the front and back of the IRS Form 1040 or IRS Form 1040 EZ) for the year prior to the year in which the application packets are due. (WILL NOT ACCEPT INCOME TAX RETURNS OF ANY OTHER YEARS). e. High School Senior Picture - A high school senior picture or a picture taken above the waistline and in color. The picture must be an original or printed on official photo paper. Do not submit any picture taken at an angle. Applicant is required to print his/her full name on the reverse-side of the picture.
f. Essay – Each candidate must provide a 500-1000 word essay focusing on “Describing his or her planned undergraduate study and how he or she plans to apply it upon graduation” or “Who is your role-model and how he or she has influenced/impacted your life”. The individual cannot be a relative. Essay technical requirements: double space, 11 point font size, one inch margin on all sides, submit original only, submit in English, and certify authorship/originality at the end of the essay. The essay will be evaluated on originality, content, thought provoking ideas, innovation, and concepts previously unpublished. Applicant must certify the authenticity of the writing at the end of the essay by affixing the below statement and then signing beneath it. “I certify that I personally wrote this essay” ___________________ Signature g. Application Submission Instructions: Do not staple or place paper-clips on any documents in the submission packet. White-out or line-through with an ink-pen any sensitive information such as social security numbers on any documents in the application submission packet.
2
Scholarship Application
Deadline: March 31st
Janice M. Scott Memorial Scholarship Fund You are to submit all documentation to The Janice M. Scott Memorial Scholarship Fund, ATTN: Mr. Abraham Scott, Post Office Box 1023, Springfield, Virginia 22151 I,
have read and understand the requirements of the Janice M. Scott
Scholarship Fund application submission process. I authorize school personnel of my high school to release transcripts of my academic record and other information requested for consideration by the Janice M. Scott Memorial Scholarship Fund Scholarship Selection Committee. I understand that this application will be made available only to qualified individuals who need to see it in the course of their duties. I waive the right to access any sealed prepared and/or written documents in support of my application submission process. If selected for a scholarship, I agree to allow my photo and mini-BIO be posted on the Janice M. Scott Memorial Scholarship Fund’s website. I also affirm the information contained herein is true and accurate to the best of my knowledge and belief.
Date
_________________
Signature
___________________________________________ *
Legal name in full (Print/Type)
Last Name
Address of Permanent residence
First Name
M.I.
Number, Street, and Apartment Number
City
Name of your High School
State
ZIP
State
ZIP
School Name
Address of High School Address
African American Caucasian Hispanic Asian
Home telephone: (
)
School telephone: (
)
Other E-mail address:
Class Rank: Number ______ out of a total of _____ Seniors
Age
Date of birth Month/Day/Year
(Check one) I am a
US citizen
Current cumulative GPA
Permanent resident
Resident alien expecting citizenship by the date of award
On a scale of
Number of member(s) in household__________. Number of member(s) in household who will be attending college during the fall semester__________.
*Parent or Legal guardian’s signature is required if applicant is under 18 years of age. Application – page 1 of 3
Name: 1. List high school activities (student government, sports, publications, school sponsored community service programs, student-faculty committees, arts, music, etc.) List in descending order of significance. High School Activities
Dates
Offices
2. List public service and community or civic activities (homeless services, environmental protection/conservation, advocacy activities, work with religious organizations, etc). Do not repeat items listed previously. List in descending order of significance. Activities/type Of work
Role/employer
Application – page 2 of 3
Dates
# of Weeks Active/Average number of hours or weeks
3. List part-time/full-time jobs, non-government interns, and government activities (internships with government agencies, partisan political activities, ROTC, municipal boards, and commissions). List student government under item 1.
4. List awards, scholarships, publications or special recognitions that you have received. List in descending order of significance.
Application – page 3 of 3
Memorial Scholarship In Memory of John Simmons, Sharon Wise, Willard Rodgers and Wesley Taylor
DUE DATE: April 1st Please mail an official transcript and a letter of recommendation with your application to: Over the Road Gang, Inc. Attn: Scholarship Committee PO Box 843, Ottawa, KS 66067 Students: Submit your application to Mrs. Allen along with your letter of recommendation. April 1 deadline. Mrs. Allen will attach a transcript and get applications to the Scholarship Committee. You may mail the application with transcript and recommendation yourself. (click on grey text box and begin typing requested information)
Student Name: Phone Number: Current School: Central Heights High School Social Security or ID# Expected Graduation Date: May 19, 2012 Home Address: Parent(s) Name: Class Rank: GPA: ACT Composite: (Scholarships are intended for students interested in pursuing automotive-related fields.) Please explain why you are interested in pursuing a degree related to the automotive industry and what career you will be working toward. What school will you be attending to get your training? When do you plan to start attending the school listed above? What are your career goals after you have completed a post-secondary program? How many days of school did you miss during the last year? Will you attend the award ceremony at your school for recognition? Yes_____ No_____ What organizations or activities have you been active in during your schooling? Why should our organization choose you to receive this scholarship? If you are given an opportunity to receive this scholarship, would you be willing to attend a meeting of the “Over the Road Gang” for an introduction to the membership? Yes ___________ No ___________
Over the Road Gang, Inc. Box 843, Ottawa, KS 66067 www.olmarais.com
PLEASE READ CAREFULLY: I understand that if I am chosen to receive this scholarship I am expected to attend classes regularly and maintain passing grades. I agree to submit first semester grades before any second semester payment can or will be made by the Over the Road Gang. Scholarship dollars will be paid directly to the school for which my scholarship was awarded only after I am enrolled in classes and proof of enrollment has been submitted to the Over the Road Gang. Half of the scholarship will be paid the first semester and the other half will be paid the second semester as long as I am a student in good standing. If I am chosen to be a scholarship recipient, I agree to provide all of the above requested information to the Over the Road Gang, Inc. before payment can be made to the school listed on my original scholarship application. The decision to change schools will require that I submit a new application. The information I have provided on this application is true and correct. Signature of Applicant:
_______________________________
Signature of Parent (s): ________________________________ _________________________________ Additional comments:
Mail applications by April 1, 2017
Over the Road Gang, Inc. Box 843, Ottawa, KS 66067 www.olmarais.com
