Lilly Endowment Community

Scholarship Programwww.jenningsfoundation.net

2017Scholarship Information

The Jennings County Community Foundation will award one (1) Lilly Endowment Community Scholarship in 2017.

The Lilly Endowment Community Scholarship covers full tuition and required fees for four (4) years of study toward a baccalaureate degree at an Indiana college or university.

JCHS Student ID No.:

Criteria for EligibilityTo be considered for the Lilly Endowment Community Scholarship, a student must fulfill

the following requirements:

Maintain a minimum cumulative high school grade point average of 8.25 (B) on a

12.0 scale, or its equivalent.

Be a resident of Jennings County and a 2017 graduate of an accredited Indiana high

school who has been accepted for a full-time baccalaureate course of study beginning

Fall 2017 at an accredited public or private college or university in Indiana.

Provide evidence of Leadership and Extracurricular Activities (scholastic honors and

awards and school-related extracurricular participation offices held, including

athletics, performing arts, clubs and similar activities.

Provide evidence of Community Involvement and Volunteer Service (non school-

related activities and employment, for example, church, scouts, athletics, arts, clubs,

volunteer, civic and similar activities, including honors and awards, offices held and

other evidence of leadership).

Submit two letters of recommendation: one letter from school personnel and one

letter from an acquaintance, excluding family members. Include letters of

recommendation with application.

Remain in good academic standing while enrolled as a full-time student pursuing a

four-year baccalaureate college degree.

Submit a typewritten essay limited to 250 words.

Participate in a LECS Selection Committee interview.

Provide a copy of your most recent high school transcript and your SAT scores.

Complete financial information.

The Jennings County Community Foundation will award one (1) Lilly Endowment Community Scholarship in 2017.

The Lilly Endowment Community Scholarship covers full tuition and required fees for four (4) years of study toward a baccalaureate degree at an Indiana college or university.

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JCHS Student ID No.: Certification

I hereby certify that I am a legal resident of Jennings County, Indiana and I authorize school personnel and/or other individuals to provide data or information about me as part of this application directly to the Jennings County Community Foundation and I waive the right to review any such submissions.

If selected as a finalist, I agree to participate in an interview with the scholarship committee.

If I receive this scholarship, it is my intent to pursue four years of undergraduate study on a full-time basis leading to a baccalaureate degree at an Indiana college. To maintain this scholarship, I must remain in good academic standing throughout the four-year period.

To assist with the processing of my scholarship payments each semester or quarter and to avoid late fees, I will forward immediately to the Jennings County Community Foundation all invoices received for tuition and any eligible fees that may be covered by my scholarship.

I agree to notify Independent Colleges of Indiana of any scholarship awards I may receive for tuition or required fees from a source other than the Lilly Endowment Community Scholarship.

I understand that the total amount of my scholarship is calculated on the basis of my chosen college’s tuition and required fees beginning with the 2017-2018 school year.

I will keep the Jennings County Community Foundation apprised annually by June 1st of my enrollment and academic status during college by completing and returning any surveys or forms as may be provided by the community foundation. Upon graduation, I will keep the Jennings County Community Foundation apprised annually by June 1st of my education and/or employment status for at least TEN YEARS after graduation, by completing and returning an alumni survey or other forms as may be provided by the Foundation.

I will account for and return to Independent Colleges of Indiana any amount of the special allocation for required books and required equipment with receipts remaining at the end of each school year.

I hereby affirm that the information provided on this application is accurate and complete to the best of my knowledge. I understand that falsification of any information may result in termination of any scholarship awarded.

The Jennings County Community Foundation has my permission to use my photograph and any general, non-financial information included in this application for publicity purposes.

Applicant’s Signature Date

Parent/Guardian’s Signature Date

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JCHS Student ID No.: Application

Student Information

NAME: Last First Middle

ADDRESS:

City State Zip

TELEPHONE: EMAIL:

Parent/Guardian Information

FATHER’S NAME: OCCUPATION:

ADDRESS (if different from above):

City State Zip

HOME PHONE: WORK PHONE:

MOTHER’S NAME: OCCUPATION:

ADDRESS (if different from above):

City State Zip

HOME PHONE: WORK PHONE:

GENERAL INFORMATION

GENERAL INFORMATION (cont.)

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JCHS Student ID No.: Please list ages and schools currently attended by your brothers and sisters, including stepfamily members. Please do not enter names.

Age Current School and Grade

Parent’s gross income levels – Indicate who the income is coming from, i.e. single parent or dual parent home. If dual, what is the income of both mom and dad? Please check one of the following: Dual Parent: Mom - Dad Single Parent$25,000 to $39,999 ____ ___ ___ ___

$40,000 to $69,999 ____ ___ ___ ___

$70,000 & Above ____ ___ ___ ___

(We reserve the right to ask for previous year tax returns or current FAFSA forms to verify

financial information.)

Have you ever been suspended or expelled from high school?

YES NO

Have you ever been convicted of a crime (actually convicted, not simply arrested) or have you been adjudicated a “juvenile delinquent”?

YES NO

If your answer is “YES” to either of the above questions, attach a statement to this application explaining the nature of the incident(s).

Current Grade Point Average: Current Class Rank: /

College Preference(s): Have you been accepted?

ACADEMIC INFORMATION

COLLEGE INFORMATION

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JCHS Student ID No.: Yes No Still Waiting

1st

2nd

Intended Major Course of Study:

Have you filed, or do you intend to file, a FAFSA form for this school year?

YES NO

Are you a Twenty-first Century Scholar? YES NO

How long have you resided in Jennings County?_______________

Attach additional sheets, if necessary and use ONLY your student ID No. for each sheet.

List all extracurricular activities including honors and awards, offices held and leadership. We must receive dates of participation & approximate number of hours per activity. For example: Marching Band – per year outside of class-room time.

SCHOOL-RELATED LEADERSHIP &EXTRACURRICULAR ACTIVITIES

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JCHS Student ID No.:

Provide a brief description of specific activities and/or responsibilities and dates of

participation & approximate number of hours per activity. If needed, you may list on

additional sheet.

EMPLOYMENT

List places of employment, length of time worked and number of hours worked per week.

Also, give a brief description of jobs performed.

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

COMMUNITY INVOLVEMENT &VOLUNTEER SERVICE

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JCHS Student ID No.:

Describe any special or unusual circumstances that you believe the LECS Selection Committee should be aware of in considering your application, including family or personal challenges and hardships and financial need. DO NOT IDENTIFY YOURSELF BY NAME.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Applicants should submit with this application two (2) letters of recommendation: one from school personnel and one from an acquaintance, excluding family members.

Letters of recommendation should describe the applicant’s character, school and/or community activities and leadership abilities. After stating the student’s name at the beginning of the letter, please refer to them as “he” or “she”.

Letters of recommendation should be addressed to:

LECS Selection Committee MembersJennings County Community Foundation, Inc.

OTHER ISSUES

LETTERS OF RECOMMENDATION

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JCHS Student ID No.:

Please write an essay to address one of the following two questions:

1. How will you use your college education to serve the community in which you will live after graduation?

2. Looking back on your life thus far, what would you change if you could?

Requirements:

1. Identify your essay using only your JCHS Student ID Number.2. This essay must be your own original work.3. Your essay must be typewritten and double spaced. It should not exceed 250

words.4. Write the word count at the bottom of the page.

Evaluation:

Evaluation components will include spelling, grammar, paragraph structure, overall composition, content and relevance.

REQUIRED ESSAY

TURN APLICATION IN TO GUIDANCE OFFICE

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