PEPPERMILL SCHOLARSHIP- APPLICATION INSTRUCTIONS Applicants 

Applicants need to complete Sections A, B, and C and turn all sections in together by due date. o Section A-Typed (fill in PDF) print completed form. (pages 2, 3, 4)  This fill-in PDF cannot be saved  The tab button will move you from field to field. o Section B-Statement of Policy Signature Required (page 5) o Section C- Hand Written (Blue ink only) (page 6) o Section D-Should be given to School Counselor to complete (page 7) o Keep this page of instructions for future reference (page 1)

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Applicants should read the statement of policy regarding the scholarship prior to completing the application. Applicants should direct any questions to the school official in charge of the scholarship program. Any incomplete applications will not be accepted. Any applications turned in after the due date will not be considered.

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School Official (Counselor)   

School Official (counselor) should complete page 7, school counselor portion. The School should notify the committee members (staff and teachers) that they cannot complete a letter of recommendation if they are on the interview committee. Transcripts must be included in the final application.

Scholarship STATEMENT OF POLICY 1. 2.

3.

4.

5. 6. 7.

8. 9.

The scholarships are given for up to a maximum of two years of college. Each yearly scholarship is issued by semester, quarter or according to the particular school’s term of enrollment. If requested of the committee and the request is reasonable, justifiable and the student is maintaining a GPA of 2.3 or better, a delay in enrollment may be granted for up to two years. Such authorization shall be granted solely at the discretion of the committee. In any case, the student will be required to re-enroll and be accepted by the school after they delay for two years and the committee so notified by the school or the scholarship will cease. If for any reason a student drops out of school before the end of a current term, the committee is to be contacted immediately. Failure to do so will immediately cancel any scholarship benefits and the scholarship will cease. If a student changes schools, the committee must be notified at once, especially if the school term differs. Failure to notify the committee can cause a delay in receiving the next check or even cancellation of the scholarship entirely. Students are requested to keep the committee advised of their current mailing address and a telephone/cell phone number at all times during the duration of the scholarship. A student receiving the Peppermill Scholarship must maintain a minimum GPA of 2.3 annually. Each student will be required to present the committee with proof of his or her GPA at the end of the first year. Students must also show intent to enroll for each upcoming term. A copy of your upcoming term’s advance registration form or class schedule will suffice. STUDENTS MUST SHOW the intent to enroll before any scholarship checks can be released for each term. It is the student’s responsibility to contact the committee on any change or variance. Failure to do so can be cause for discontinuing any scholarship. The committee’s decision is final and any discontinuation or change granted by the committee concerning a scholarship will be binding on the student applicant.

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PEPPERMILL SCHOLARSHIP APPLICATION Section A

Name:

Date of Birth:

Address:

Phone Number:

Father’s Name:

Father’s Occupation:

Mother’s Name:

Mother’s Occupation:

Number of siblings living at your home:

Siblings currently in college:

List the college(s) that your siblings are attending:

List the college (s), university or trade school that you have applied:

List the college (s), university or trade school that you have been accepted:

Career Choice (1)

(2)

List two people for reference, including their addresses. These references should complete a letter of reference for you and provide that letter in a sealed envelope that is included with your application. You may not include relatives. You may only list one person from your school. The other reference should be a community leader, employer or friend that can provide a personal reference of character. 1. 2.

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PEPPERMILL SCHOLARSHIP APPLICATION Application continued List the school/community/church activities that you are involved in: Name of Organization Title or Duties

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PEPPERMILL SCHOLARSHIP APPLICATION Application continued

List the award(s) or achievement(s) you have received during the last 4 years in your community/church or school organization:

List all previous job experiences, beginning with the most present employer and working back. Please list any volunteer work as well.

List all scholarships or grants that you have applied for:

List any scholarships or grants that you have received and list the terms and amount(s) granted. Scholarship or Grant Name Length Amount

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PEPPERMILL SCHOLARSHIP APPLICATION Statement of Policy Section B

1. The scholarships are given for up to a maximum of two years of college. Each yearly scholarship is issued by semester, quarter or according to the particular school’s term of enrollment. 2. Delayed enrollment after completion of one semester or year of college: If requested of the committee and the request is reasonable, justifiable and the student is maintaining a GPA of 2.3 or better, a delay in enrollment may be granted for up to one year. Such authorization shall be granted solely at the discretion of the committee. In any case, the student will be required to reenroll and be accepted by the school after they delay for one year and the committee so notified by the school or the scholarship will cease. 3. If for any reason a student drops out of school before the end of a current term, the committee is to be contacted immediately. Failure to do so will immediately cancel any scholarship benefits and the scholarship will cease. 4. If a student changes schools, the committee must be notified at once, especially if the school term differs. Failure to notify the committee can cause a delay in receiving the next check or even cancellation of the scholarship entirely. 5. Students are requested to keep the committee advised of their current mailing address and a telephone/cell phone number at all times during the duration of the scholarship. 6. A student receiving the Peppermill Scholarship must maintain a minimum GPA of 2.3 annually. Each student will be required to present the committee with proof of his or her GPA at the end of the first year. 7. Students must also show intent to enroll for each upcoming term. A copy of your upcoming term’s advance registration form or class schedule will suffice. STUDENTS MUST SHOW the intent to enroll before any scholarship checks can be released for each term. 8. It is the student’s responsibility to contact the committee on any change or variance. Failure to do so can be cause for discontinuing any scholarship. 9. The committee’s decision is final and any discontinuation or change granted by the committee concerning a scholarship will be binding on the student applicant.

In the event that I am awarded the scholarship, I hereby agree to the terms set forth in the scholarship policy. I have read and understand the terms set forth by the Peppermill Scholarship.

Printed Name __________________________________

Signature______________________________________

Date ___________________ 5

PEPPERMILL SCHOLARSHIP APPLICATION Written summary- Section C This section must be hand written by the student in blue ink.

Write a summary below that describes your educational or vocational goals and that also explains the reasons why you have selected these goals. Please initial the page when you are finished in the bottom right corner of this page. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

Applicant Name ______________________________

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PEPPERMILL SCHOLARSHIP APPLICATION School Counselor Section D

Student/Applicant Name: ________________________________________________________

Cumulative GPA: ___________________________ACT/SAT Score: ____________________________

**Please attach the official transcript.

Counselor’s Signature ____________________________________Date: _____________________

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