Community Foundation of Randolph County

Scholarship Application

213 S. Main, Winchester IN 47394

Scholarship Name: Rosemary Shockney Memorial Scholarship

Criteria: Student must be in the top 10% of his/her class and demonstrate financial need. Preference will be given to students in band or students who bowl or come from a bowling family. Application must be typed and returned to the Community Foundation office before 4:30 p.m. on March 22, 2018.

Name: ______

Address: ______

City/Zip: ______

Telephone: ______Cell Phone: ______

Email: ______

Name of Parents/Guardians: ______

GPA: ______Class Ranking: ______

Name & Address of University, College or Vocational/Technical School you plan to attend

______

____ College/University _____Vocational/Technical School Accepted? Yes or No

Is the school accredited? Yes or No Is the school a not-for-profit school? Yes or No

Will be enrolled _____ Full Time _____ Half Time _____ Less than Half Time

Major: ______

Minor: ______

List all extra-curricular school and community activities that you have participated in during the past four years. (Include: activity name & length of participation)

Activity 9 10 11 12

Describe your work and/or volunteer experience during the past four years. (Include: place of employment, position, length of employment and hours worked per week.)

Activity 9 10 11 12

List any honors/awards you have received 9 10 11 12

Please describe your goals and plans for the future (responses should be limited to one page double-spaced with 12 point font)

Financial Information

What is the yearly cost of tuition at your chosen college?

Will you live on campus? If so, how much is room and board?

Have you completed the FAFSA or College Cost Estimator? If so, what is your EFC (Expected Family Contribution) from that form?

Are you a 21st Century Scholar?

If you are a 21st Century Scholar and you are planning to attend IU or Purdue, have you applied for and been awarded the IU Covenant or Purdue Promise?

Please explain any special circumstances that you feel may affect your ability to pay for college that are not reflected in your EFC. Use as much space as needed to provide an adequate explanation.

“I hereby promise that the information provided in this application is accurate. I also understand that Community Foundation Scholarships may only be used at accredited, non-profit institutions”

Applicant’s Name (printed) ______

Applicant’s Signature ______

Date ______