JCHS Student ID No._____________________

NAME:______________________________________________________________________

PLEASE CHECK ALL SCHOLARSHIPS YOU ARE APPLYING FOR:Make sure to send one copy of the checklist, application, transcript and required material for EACH scholarship you are applying for. (Example – Applying for 5 scholarships would require 5 checklist copies, 5 application copies and 5 transcript copies, plus any additional information required for a particular scholarship.)

___Cecil H. Boardman Skilled Trades – Students pursuing a degree in the Skilled Trades___Anthony Burton – Preference will be given to a student pursuing a degree in law enforcement or criminology. There is also an essay on that must be completed.___Brush Creek PTO – Iva Wilder Memorial – For students who attended Brush Creek Elementary___Burlin B. King – 4-year renewable scholarship – must have weighted 9.0 GPA to apply___Chad Earnhart – Students pursuing a degree in Engineering attending a college or university in Indiana___Charles & Mildred Hurley – Attend Indiana University or one of its regional campuses___Daniel J. Elsner – Students who are likely to succeed in their post-secondary studies. There is also an essay on that must be completed. ___Dennis Mills – Students pursuing a degree in Engineering___Francis Brooks Hicks – Will attend an Indiana college or university & will major in elementary education___Dorothy Hollister Hall, Bruce Hollister Hall & David Custer Hall – A senior who has demonstrated integrity of

Character, academic success, & good school citizenship and pursuing a 4-year degree. There is also an essay on that must be completed.

___Jan Ludwig – Senior who plans to enter the field of special needs education___Jennings County High School Alumni – JCHS graduates deserving of financial assistance and who are likely to Succeed in their post-secondary studies.___Jennings Water/Ed Wessel Memorial –A student whose parent/guardian are a member of Jennings Water, Inc. Provide name_________________________________________________________Joan Marsh Bentz – Attend Purdue University or Indiana University___Jordyn E. Vance – St. Mary’s School Memorial – Must be a graduate of St. Mary’s School. There is an essay that must be completed on how St. Mary’s impacted your life.___Josiah Yeager – Students who have participated in varsity athletics___Louise ‘Pete’ Clerkin – Senior girl who has been a member of the JCHS golf team___Luke Johnson – Applicants must be a graduating high school senior and must complete and include a 150 word essay (please attach to the application) regarding abstaining from drug and alcohol use. ___Margaret C. Jackson – Student majoring in elementary education___North Vernon Elementary PTO/Tara Montgomery Burnett – Attended NVE & maintained a GPA of 3.0 or above___North Vernon High School Alumni – Descendant of NVHS graduate (provide name & Date Graduated)__________Paris Crossing Alumni – Resident of Lovett, Marion or Montgomery Townships___Richard & Anna Marie Mayer – Graduate who will attend an accredited 4-year college or university___Eric Berkshire Scholarship for the Arts – Student pursuing a career in the arts – music, visual or written___Stephen E. Jones – Student who plans to pursue a degree in the field of music education, preferably voice___Sue Ellen Jones – JCHS graduates who are admitted to an Indiana college or university for elementary education and Who have attended North Vernon Elementary or Brush Creek Elementary ___Tod A. Sporleder – Students that have participated in 4-H and/or band. List how long participated, what the activity was & if currently a member_______________________________________. (you may list separately)___Vernon High School Alumni – Senior who is a descendant of a Vernon HS graduate. Must list descendant &

& your relationship________________________________________________________. (Previous scholarship recipients may re-apply for another year’s scholarship the following year.)

___Frank & Amanda Carlock – Resident of Paris Crossing or Hayden. Must attend an Indiana university or college___Luke Elsner – Students pursuing a career in an agricultural field or from an agricultural background___Mary Louise Schonfeld – Student who participated in “girls” sports & who are likely to succeed ___Scipio Alumni – Attended Scipio Elementary & a graduate from JCHS

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JCHS Student ID No.________________________Roy & Lena Kinder Memorial Scholarship – Deserving students who are a resident of Lovett, Marion or Montgomery Townships who are likely to succeed in their post-secondary studies.___Morgan Wright – Students pursuing a degree in nursing or a fast pitch athlete pursing further education at a college or university.___Rondal Lee Ballard/Adrian – A student who attended Scipio Elementary and a student who attended St. Mary’s School (CIRCLE WHICH SCHOOL) ___Bob Barber Memorial – A student participating in baseball and a student who participated in golf. Circle which one. ___Paul Todorovich Memorial – Students majoring in the field of education with the intent of becoming a teacher___Lance Green Memorial – Student who is most likely to succeed in their post-secondary studies___Jerry & Joe Goss Memorial – JCHS senior who has been an active member of band or orchestra for at least 3 years___Women’s Giving Circle Scholarship – Must have attended one Reach Conference during their career at JCHS – List year/years___Robert & Florence Cardinal – A student that has faced a health related obstacle.___Jerry Earl Memorial – A student majoring in education at Indiana University – All campuses___Donnie Ellerbrook Scholarship – A track athlete graduating from JCHS ___Jennings County ARC – A student pursuing a degree in the field of special education___Chick Helm Memorial – Student furthering his/her education in the field of music___Branden Back Memorial – Student pursuing a nursing degree___Memories of Bigger Township – must be resident of Bigger Township___Mark McCammon Scholarship – An athlete graduating from JCHS who has participated in track and/or cross country for 2 years, one season being in the senior year with no panther coded violations & has been accepted to an institution of higher learning – 2 or 4 year accredited institution.___Regal Rug Scholarship – Students who are sons or daughters whose parents or grandparents were employed by Regal Rug for at least 2 yrs. And in the top 40% of their class. Provide name___________________________________. ___Marilyn & Warren Guild Engineering Education Scholarship – A student majoring in any field of engineering___Eric Thompson Memorial Scholarship – Students who are most likely to succeed in their post-secondary studies___Bob & Joan Belschwender Memorial Scholarship – Students who are most likely to succeed in their post-secondary studies___Muscatatuck Board of Realtors Scholarship – Students graduating from Jennings County who will be attending a public or private institution of higher learning.___Sue A. Beesley Scholarship – Student graduating from JCHS who will attend DePauw University.___Branham Family Scholarship – For students who are accepted into and attend accredited two or four-year public or private Institutions of higher learning.___JCS Nutrition Association Scholarship – Students going into Food Service. Food Service. ___Donald Hearne Scholarship – For students who are accepted into and attend accredited two or four-year public or private Institutions of higher learning.___Aaron Michael Sporleder Scholarship – JCHS graduate who is a special needs student who will be studying to become a Special education teacher. ___Jacky Koenig, Jr. Memorial Scholarship – To provide scholarships to track and field or cross country to JCHS students who are continuing their education.___Class of 2015 Scholarship – Support for educational scholarships for students accepted into 2 or 4 year public or private institution.___Merrill & Joyce Salyers Scholarship – JCHS students who are studying for guidance or industrial Arts.___Les Carson Memorial Scholarship – Qualified students who are pursuing studies in Animal Science.

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JCHS Student ID No._____________________

INSTRUCTIONS

Please read the application checklist and application form very carefully before you fill it out.

Put a check mark by the scholarships you are applying for – make sure you are eligible.

On the first page of the application, there is a certification for your signature and your parent/guardian’s signature.

Some of the scholarships require additional information that is stated on the application checklist. (Example – Tod A. Sporleder – Students that have participated in 4-H and/or band. List how long participated, what the activity was and if currently a member. You may use a separate piece of paper to list this information; however, if this information is not included, your application will not be considered.)

There is an essay question on page 5 that must be answered by everyone. Some scholarships require an additional essay. (Example – If you are applying for the Daniel J. Elsner scholarship on page 4, there is an additional essay to answer.)

Applications must include two letters of recommendation one from school personnel and one letter from an acquaintance, excluding family members. Include letters of recommendation with application.

THE APPLICATION AND CHECKLIST ARE AVAILABLE ONLINE AT www.jenningsfoundation.net

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JCHS Student ID No._____________________

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JCHS Student ID No._____________________

NAME:_______________________________________________________________

Last First Middle

ADDRESS:____________________________________________________________

_____________________________________________________________

City State Zip

TELEPHONE:____________________________ EMAIL:_______________________

Parent/Guardian Information

FATHER’S NAME:_______________________________________________________

ADDRESS (if different from above):_________________________________________

MOTHER’S NAME:______________________________________________________

ADDRESS (if different from above):_________________________________________

Parent’s gross income levels – Please check one of the following: 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).

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JCHS Student ID No._____________________

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).

TRANSCRIPT MUST BE ATTACHED TO BE ELIGIBLE

Current Grade Point Average:___________ Current Class Rank: _____/________

SAT Score: Math:_________ Verbal:_________ Act Score:__________

College Preference(s): Have you been accepted?

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

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JCHS Student ID No._____________________

Other Awards:

Please list below the name and amount of any grants or scholarships that you have been awarded for the coming school year.

Name of Award Amount Granted Pending

School Activities: List ALL extracurricular activities including honors and awards, office held, leadership activities and dates of participation.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________

Employment: List employer, position held and dates. (begin with most recent job)

____________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Special Circumstances : Please describe any unusual and/or family or personal circumstances that you feel should be considered in evaluating your application.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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JCHS Student ID No._____________________In addition to the required essay, if you have selected (checked) any of the following scholarships, please write a brief response to the questions that apply. Attach additional sheets if necessary.

Women’s Giving Circle – What did you like most about the REACH conference and what would you change, if anything.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

Anthony Burton – Briefly summarize your educational goals for the next five years.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Daniel J. Elsner - Write a brief essay describing the ways in which you believe the use of alcohol and other drugs may affect a young person’s life and describe a program you think would be effective for middle and high school students to educate them about the effects of and ways to prevent the use of drugs and alcohol. What factors do you think contribute to the use of drugs and alcohol among young people today?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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JCHS Student ID No._____________________Dennis Mills – Briefly summarize your educational goals for the next 5 years________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dorothy Hollister Hall, Bruce Hollister Hall & David Custer Hall – Briefly summarize your educational goals for the next 5 years._

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________

Jordyn E. Vance – St. Mary’s School – How has your life been influenced by attending St. Mary’s School? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Scipio Alumni – Submit an essay providing information about your background, interests, education plans, career goals, and why you should be considered for this scholarship. Your essay must be typewritten, double spaced and should not exceed 250 words. Also, please provide a copy of your transcript. List years attended Scipio Elementary School.

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

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JCHS Student ID No._____________________

REQUIRED ESSAYPlease write an essay to address one of the following questions.

1. Tell us about an activity you did in school or the community that demonstrates leadership skills.2. Imagine yourself 10 years from now. What will you be doing and how will you be contributing to your community.

1. This essay must be your own original work.2. Your essay must be typewritten and double spaced. It should not exceed 250 words.3. Write the word count at the bottom of the page.

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

BE SURE YOU HAVE INCLUDED THE FOLLOWING:

ONE COPY OF THE APPLICATION AND CHECKLIST FOR EACH SCHOLARSHIP YOU HAVE APPLIED FOR.

BE SURE TO INCLUDE THE TWO RECOMMENDATIONS

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