an affiliate of Central Kansas Community Foundation
ERNEST FRANK HORN, JR.
ENDOWED SCHOLARSHIP APPLICATION
The purpose of this scholarship is to provide financial assistance to current graduating seniors attending an Elk County high school who are furthering their careers through higher education or vocational pursuits. Qualified individuals are those pursuing a degree in education and planning to become an elementary or secondary school teacher. Priority will be given to individuals who reside in Moline, Kansas, demonstrate financial need, and are eligible for membership in the Moline Alumni Association.
Scholarship award will be in the amount of $500. Applicants will be notified in May of their award status.
Application due April 3, 2015
Section I. Information to be supplied by applicant.
Student Name: ______
First Middle Last
Date of Birth: ______□ Male □ Female
Permanent Address: ______
Number/Street
______
City State Zip
Home Phone: (_____)______Cell Phone: (_____)______
Email Address (Please do not use your high school email address): ______
Father or Guardian (if under 18 years old)
Name: ______
First Last
Mother or Guardian (if under 18 years old)
Name: ______
First Last
What high school are you currently attending?
Are you eligible for membership in the Moline Alumni Association?
□ Yes □ No
What college, university, or vocational school do you plan to attend during the Fall semester?
Academic classification for the Fall semester:
□ Freshman □ Sophomore □ Junior □ Senior □ Graduate Student
What is your admission status to the college or university listed above?
□ Pending □Admitted □ Denied □Wait List
College,University, or Vocational School Address: ______
Number/Street
______
City State Zip
Student ID # (if available): ______
Will you be attending college full time during the Fall semester? □ Yes □ No
What career are you pursuing? Please elaborate (specialty area/emphasis of study, etc.).
What is your anticipated tuition for the upcoming school year? $ ______
Have you completed the FAFSA(Free Application for Federal Student Aid)?
□ Yes □ No
If yes, do you qualify for need-based financial aid?
□ Yes □ No
Have you been granted any other scholarships and/or grants for the coming school year?
□ Yes □ No
If yes, please list the name of all other scholarships and/or grants in which you have been granted including their value.
Number of dependents living in your household(including self): ______
Number of people living in your household who will be attending college as a full-time or part-time student next semester (including self): ______
Are there any special financial circumstances that will affect your education?
□ Yes □ No
If yes, please share any relevant information that helps demonstrate your current financial situation.
List any high school and/or community activities (e.g., clubs, debate, student government, fine arts, youth programs, athletic programs, music, scouting, church) that you have been involved in within the past four (4) years. Please provide number of years you contributed to each activity and if you held a leadership role.
Please list special recognitions, awards, and/or honors you have received within the past four (4) years. Include honorary organizations in which you belong or have belonged.
List any community service/volunteer activities you have been involved in within the past four (4) years. Please provide number of hours that you contributed to each activity.
Please write a personal essayaboutyourself, the fieldyou havechosen to study,and your career aspirations (maximum 500 words).
***********************************
I certify the information provided in this application is accurate and complete to the best of my knowledge. I understand failure to provide full documentation or falsification of credentials will result in disqualification of this application. In the event I receive a scholarship award and elect not to attend school during that school year, the award will be returned to the Ernest Frank Horn, Jr. Endowed Scholarship Fund.
______
Applicant Signature Date
Section II. Information to be supplied by high school guidance counselor.
ACADEMIC VERIFICATION FORM
Attach a copy of applicant’s most recent transcript.
I certify that the student listed below is a student in good standing and is in line to graduate at the end of this school year. I have verified their GPA, ACT and/or SAT composite score, and Class Ranking below.
Student Name: ______
High School GPA: ______ACT Composite Score: ______SAT Composite Score: ______
Class Rank: ______
Will/did the student listed above complete the Kansas Precollege or Kansas Scholars Curriculum?
□ Yes □ No
Date of high school graduation will be ______, ______.
______
Counselor Signature Date
Print Counselor Name: ______
Please submit this application form along with:
- A copy of your most recent transcript.
Completed applications should be
emailed to
or mailed to
Elk County Community Foundation Scholarship
c/o Shirley Black
P.O. Box 1218
Howard, KS 67349.
Ernest Frank Horn, Jr.
March 4, 1920–February 22, 2014
Ernest Frank Horn, Jr. was born March 4, 1920, in Moline, Kansas.He married Dorothy Fee on Feb. 19, 1943; she died in 2004.
Frank earned his bachelor's degree in 1942 and his master's degree in 1949, both fromPittsburg State University in Pittsburg, Kansas.
He served in the U.S. Navy during World War II. Frank’s career included 37 years as a football and basketball coach, business education teacher, and public school administrator in Kansas and in Cedar Falls, Iowa. He retired from the Cedar Falls Community Schools in 1983.
Elk County Community Foundation, an affiliate of Central Kansas Community Foundation,manages the Ernest Frank Horn, Jr. Endowed Scholarship Fund. If you have questions or need further information, please contact Chancy Gerbitz at or 316.283.5474. Additional information posted at .
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