Ben Hartsock Scholarship Fund
Guidelines for Application
1. Nominee must be a graduating senior of Chillicothe High School or a Scioto Valley (Ohio) Conference School.
2. Nominee must complete an application complete with a picture.
3. Nominee must provide a one page autobiography (250 words or more) describing himself/herself and his/her interests, hobbies, and goals.
4. Nominee must provide an information sheet that includes activities in which the nominee has engaged during high school years (class officer, music organizations, athletics, publications, etc.) and organized out-of-school activities (4-H Club, scouting, church organizations, etc.). Information sheet should also include any awards or honors received.
5. Nominee must include two letters of recommendations from teachers, coaches, advisors, or other community leaders.
6. Nominee shall provide a high school transcript from his/her high school.
7. Nominees will be evaluated on:
· Academic Excellence
· Athletic Excellence
· 4-H Excellence
· Community Service
8. Scholarship funds may be used at any accredited college or trade school.
9. Scholarship funds may be used for books, tuition, or room and board. Checks will be written directly to the college, trade school, or approved entity. Any unused portion will be returned to the fund.
Applications should be returned to your guidance office or by mail or email to:
Ben Hartsock Scholarship Fund
Chillicothe-Ross Community Foundation
45 E Main St
Chillicothe, Ohio 45601
Ben Hartsock Scholarship Fund
Student Application Form
I hereby apply for a college scholarship and submit the following information.
Name: Date of Birth:
Address:
Phone #:
Social Security #:
Parent or Guardian: (father/stepfather)
Parent or Guardian: (mother/stepmother)
Number of younger brothers or sisters:
Number of brothers or sisters attending college:
High School Class Rank:
A.C.T. Composite Score:
Name and Address of College, University, or Trade School you plan to attend:
Name of Admissions Officer:
Phone & Extension # of Admissions Officer:
What College, University, or Trade School degree do you currently hope to achieve?
What Career/Field do you wish to enter with this degree?
Attachments
Please include the following attachments:
· Proof of acceptance by the school of your choice
· High School transcript
· Two letters of recommendations from teachers, coaches, advisors, or other community leaders
· Write a listing of recognition you have received for outstanding schoolwork, i.e. honors, prizes, or scholarships.
· List the activities in which you have engaged during your high school years. Include in the list organized out-of-school activities (4-H Club, scouting, church organizations, etc.) as well as those connected with school (class officer, music organizations, athletics, publications, etc.).
· Self Expression Synopsis
o Write an essay of at least 250 words, describing yourself; your interests, hobbies, and goals; and your church, school or community involvement.
· Please include a picture or senior picture.
Ben Hartsock Scholarship Fund
Statement of Proposed Budget for the Coming Year
Anticipated Sources of Income
Scholarship/Grants: $
Loans: $
Summer Work: $
Family Contributions: $
Other: $
Total Income: $
Estimated Expenses
Tuition & Fees: $
Room & Board: $
Books: $
Travel Expenses: $
Miscellaneous Expenses: $
Total Expenses: $
Ben Hartsock Scholarship Fund
RELEASE
I hereby certify that all statements contained in the foregoing application are true and correct, that I have read the description of the Ben Hartsock Scholarship Fund, that I believe myself eligible to apply for a college scholarship under the provisions and conditions it contains, and I authorize my school to provide information to the Selection Committee upon request. Should I receive the scholarship, I authorize my picture to be used in promotional and news material (including print and internet) concerning the scholarship.
Signed: Date:
(Student)
This application and certification and release are true and correct and meet with my approval.
Signed: Date: (Parent)