Revised: Dec 15,2015
2015-2016Check-Off Sheet
Students, please obtain a copy of this page at your guidance department or use this print out
AdamsCounty Community Foundation
102 N. 2nd Street, Decatur, IN46733
email: / phone: 260.724-3939/
hours: M-F, 8:00 am – 4:00 pm
website:
It is expected that this page will be completed neatly handwritten. Please use a blue or black ink.
Applicant’s name (last/first):______, ______
Last name First name student’s phone: 260.______(circle one:this is my cell / home ph)
email addresses:
Address: ______city: ______IN zip: ______school: ______non-school: ______
college: (1st choice)______( 2nd )______
major: (1st choice)______( 2nd )______
Targeted educational degree:___ 4 year degree / ___ 2 year degree….for a 2-yr degree, the shorter application may be submitted
If my first choice is an out-of-state school and I am considered for a Lilly Endowment Scholarship, I may change my direction….
__ Yes, I will attend an Indiana school if awarded the Lilly Scholarship.
__ No, I am determined to attend an out-of-state school. Please consider me for other scholarships.
Initial _____ to verify you have read and agreed to the above.
List scholarships already awarded: ______* (ex.: 21st Century Scholarship/ Scholarship from your college / etc.)
*withholding information regarding scholarships already awarded to the student will certainly affect the student’s standing with the ACCF
Please place this four-page info sheet on the very top of all your applications secured with a rubber band, string, ribbon, or in one large envelope – anything that secures the 10 applications together. This security item is for office use only and will be removed shortly after the application has been placed in the appropriate scholarship listing. Taking great efforts to secure the applications with something unique or costly is not necessary.
How to access the AdamsCounty Community Foundation (ACCF) Scholarship Application:
You may go to the ACCF website or your high school’s website page – ‘Scholarships’
Save: To download the ACCF Application: dbl click on ‘Read-Only’ (no password is necessary)
To save your application: use a different title (the application is a locked doc, therefore, each time you make changes and
wish to save the new form, you will need to save it under a new title)
Needed: Two letters of recommendation (in compliance with the instructions as shown on the application)
One full transcript (seven semesters)
Submit 10 copies of this application packet following the instructions as listed on the application
Do not miss the due date. Applications submitted after the due date will not be considered for review.
Note: “For Proof-of-Association Forms”, obtain at your guidance department
All Adams County graduates / 2 or 4 year degreerequirement summary
___ Lilly Endowment Community ScholarshipIndiana college, GPA,SAT,ACT mini. requirements reviewed
___ Andy and Bessie Appelman ScholarshipStudent has association with West End Restaurant (current or past employee)
___ AHA IN – in memory of Ralph Biggsstudent lives in an AHA housing apartment
___ Adams County Coon Hunters Scholarship student is an outdoors enthusiast (hunter / trapper)
___ DDS – Decatur Dental Services Scholarship major: dental care
___ Trooper Cory Elson Memorial Scholarshipessay req. –refer to scholarship description for topic details
*new ___ 4-H (Four-H) Scholarship 4-H member / final / 10 year
___ (Adams Co.)Hospital Auxiliary Scholarshipmajor: heath care
___ Knights of Columbus ScholarshipCatholic Church Association (male students)
___ LutheranSchool of Nursing (LSN) Scholarshipmajor: heath care / nursing
___ Mark P. Merkel / 4-H Scholarship4-H member / final year
___ Meshberger/ LICA ScholarshipMeshberger/LICA association,Proof of association req&/or Engineer maj.
___ Nick Taylor / Smith Bros Fur. ScholarshipSmith Brothers Furniture association, Proof of association required + essay
___ Officer Jerry Wyss Memorial Scholarshipessay req. – refer to scholarship description for topic details
(cont) More all schools
1 / 4
All Adams County graduates / 2-year degree candidatesrequirement summary
___ David Baily Memorial Vocational ScholarshipVocational occupation / 2-yr or ACCF 4-yr application
___ Ehrman Vocational Scholarship Vocational occupation / 2-yr or ACCF 4-yr application
*new ___ Doyle & Anna Lehman Family Scholarship major: career and technical education/ vocational-tech. (priority to SA students)
*new ___ Decatur Optimist Club Scholarship major: vocational-tech.
___ James Rumple Memorial Vocational ScholarshipVocational occupation / 2-yr or ACCF 4-yr application
*new ___ Dennis &Sylvia Scheumann Scholarship Education goal: Vocational occupation(healthcare or mechanics)
2015-2016
Adams County Schools
A.C./N.A. graduates only:
___ American Legion, Post #43 ScholarshipAm Legion, Post #43 association, Proof of association req.
___ Dixie (Harvey) Arven Memorial Scholarship Military association Proof of association required
___ Barkley-Pettibone Memorial ScholarshipAC: high academics, financial need reviewed
NA: high academics, recognized athlete
___ Decatur Volunteer Fire Department ScholarshipCommunity Association Proof of association required
___ Mark’s Heating and Air Conditioning Scholarship Education goal: Vocational occupation
___ Bryan Miller Memorial Scholarship essay req. – refer to scholarship description for topic details
___ Decatur Optimist Club Scholarship Vocational occupation / 2-yr or ACCF 4-yr application
*new ___ Medford and Shirley Smith Memorial Scholarship St. Joseph School Alumni / GPA: 3.0+
___ Elizabeth ‘Liz” Souder Memorial Scholarshipmajor: Education, Journalism
*new ___ Richard ‘Hap’ Sprunger Memorial Scholarship major: vocational occupation, involved in sports
*new ___ Kelly J. Zeser Memorial Scholarship major: creative arts, visual or preforming arts
A.C./S.A. graduates only:
___ (the) Nut Tree Reading Scholarship essay req. – refer to scholarship description for topic details
“How Reading Has Impacted My Life”
2015-2016 Individual Adams County Schools
A.C. graduates only
___ Carolyn Donaghy Memorial Scholarshipcollege: Taylor University - Upland
___ Encore Scholarship (memory of Theodore Heller)major: Music, fall enrollment
___ John A. Geimer Memorial Scholarshipmajor: Music, Comm., History, or Poli Sci
___ Kipfer Family Memorial Scholarshipmajor: Education / music
Plus: ___ Adams Central ScholarshipsAC Scholarship Committee uses this application and due date – please contact
the AC guidance department to learn of any modifications.
N.A. graduates only
___ Craig and Sue Anderson Scholarshipmajor: Education
___ Bird- Walther Memorial ScholarshipPriority: music major
___ Eleanor J. Bressler Memorial Scholarshipmajor: Education / Healthcare, St. Joe School Association
*new ___ Brune Engineering Scholarship Fund major: Engineering, GPA
___ Fern DierkesMemorial Nursing Scholarshipmajor: nursing
___ Don and Helen Forst Memorial Scholarshipfinancial need reviewed / shown (awarded in June)
___ Fruechte Farms / NA Voc/Trades Scholarshipmajor: Trades or Vocational Occupation
___ Rick Girod Memorial Scholarshipwork ethic reviewed
*new ___ Mary JoHoffmanMemorial Scholarship 2 or 4 year degree, need reviewed
___ Meghan Hormann Memorial ScholarshipPriority: music major
*new ___ Kenneth/ Geraldine McConnell Meml Schmajor: business or healthcare
___ Rosanne Miller Memorial Scholarshipformer St. Joe student
___ Don Ray Memorial Scholarship academics and school involvement reviewed
___ Sandy Sailsbery Memorial Scholarshipmajor: Education
___ Mark Stevens Memorial Baseball Scholarship current varsity baseball player
___ Emily C. Wilder Memorial Scholarshipmajor: Education priority/health care considered
Plus: ___ North Adams ScholarshipsNA Scholarship Committee uses this application and due date – please contact
the NA guidance department to learn of any modifications.
(cont) More schools
2 / 4
S.A. graduates only
___ American Legion, Post #468 ScholarshipAm Legion, Post #468 associationProof of association req.
___ Herman Bixler Memorial Scholarshipmajor: Business
*new ___ Gregory Drake Memorial Scholarshipmajor: Business
___ Thomas Neal Dull Memorial Baseball Scholarship current varsity baseball player
*new ___ EXCEL! / Lehman Family Scholarshipstudent that has shown notable excellence
___ Geneva Proud Memorial Scholarshiplives in zip code area: 46740
___ David Habegger Memorial Scholarshipmajor: Sports related field
___ Derryl Lehman Memorial Scholarshipmajor: Agri-business
*new ___ Doyle & Anna Lehman Family Scholarship major: career and technical education/ vocational-tech. (also listed above)
*new ___ Jessica Lehman Memorial Scholarship major: education, health care, social work
___ Harold and Dora Ann Long Scholarshipmajor: Education
___ Scott Mathys Memorial ScholarshipGPA priority: ‘C’ level student
*new ___ McDonald Education Scholarship major: Education (priority: Elementary Education)
___ Amy Meyer Memorial Scholarshipfemale athlete
*new ___ Peter Minnich Memorial Scholarship major: business, creative design, horticultural or agriculture or creative design
*new ___ WilliamMorris Memorial Scholarship major: business
*new ___ Ted SchwartzMemorial Scholarshipmajor: visual arts, art-ed., illustration, interior/graphic design, photography, etc
___ Clayton Shuck Memorial ScholarshipFFA Association
*new ___Phyllis Speicher Scholarshipmajor: education, science, math, engineering, computer science
*new ___Betty Jean Jones-SeffernickScholarshipmajor: healthcare
___ Nick Taylor Memorial ScholarshipTBA
___ Kenneth and Eula VanEmon Scholarshipmajor: Education
Plus: ___ South Adams ScholarshipsSA Scholarship Committee uses this application and due date – please contact
the SA guidance department to learn of any modifications.
*New scholarships listed may be awarded in 2016 (or 2017) as these are based on the 2015 investment returns.
End – Scholarship Check off sheet - above scholarships: due date: Thursday, February 5, 2015 by 4:00* pm in the ACCF office
Adams County Community Foundation
102 N. 2nd Street / Decatur, IN 46733 / Phone: 260.724-3939 / Email:
Office hours: Monday – Friday, 8:00 am – 4:00 pm or Mail slot drop-off: Madison Street door: 24 / 7
Want to stop by before or after hours? Please use the mail slot on the ACCF Madison Street door.
Announcements
- ACCF Scholarship Application
This is the first year all schools (AC, NA, and SA) are using the ACCF Application. It is in the students’ best interest to review carefully their application for typos, grammar, and clarity as this application does not have spell-check.
Applications that are computer generated are often viewed by the reviewer as a student who has a greater interest in the scholarship competition.
- Note: New ACCF Scholarship Opportunities:
Due to a generous matching program, the Adams County Community Foundation experienced a growth in the number of scholarship funds. Some of the new funds listed may opt to award their first scholarship in 2016. This will be determined on a case-by-case basis.
- Awards announcements:
Unless otherwise stated, the announcement of these awards will be at the student’s high school awards event. In 2015 these are scheduled as:
Adams Central: Monday, May 9, 2016
North Adams: Wednesday, April 27, 2016
South Adams: Thursday, April 28, 2016
For a more complete listing and details of scholarships please go to the ACCF website:
Then to: 2016 scholarships / descriptions
Efforts have been made to list all scholarships free of typos or errors. Please accept our apologies if errors are noted.
(cont) More student information
3 / 4
2015-2016 graduates
Supplemental Eligibility Sheet
(this may qualify you for more scholarship opportunities)
Students, please obtain a copy of this page at your guidance department or use this print out
AdamsCounty Community Foundation
102 N. 2nd Street, Decatur, IN46733
email: / / ph: 260.724-3939 / hrs: M-F, 8:00 am – 4:00 pm
It is expected that this page will be completed neatly handwritten. Please use a blue or black ink.
Please staple this page to the Check-off Sheet (available at your guidance department)
Applicant’s name (last/first):______, ______
Last name First name
Targeted educational degree:
__ 4 year degree
__ 2 year degree….for a 2-yr degree, a 2-yr or 4-yr application may be submitted
Important for some scholarship selected committees:
Involvement / Interests:
As some committees use this for decisions, please check off your involvement and the years involved (to-date): / pls circle one:
__ Automotive tech# yrs: 1-3 / 4-6 / 7-10+
__ Hunting / Trapping# yrs: 1-3 / 4-6 / 7-10+
__ Shooting Sports # yrs: 1-3 / 4-6 / 7-10+
__ 4-H: # yrs: 1-3 / 4-6 / 7-10+
__ FFA: # yrs: 1-3 / 4-6 / 7-10+
__ Band:# yrs: 1-3 / 4-6 / 7-10+
__ Music:# yrs: 1-3 / 4-6 / 7-10+
__ Choir:# yrs: 1-3 / 4-6 / 7-10+
__ Dance (community programs):# yrs: 1-3 / 4-6 / 7-10+
__ Theater /Drama /Performing Arts:# yrs: 1-3 / 4-6 / 7-10+
__ Creative Arts (painting, sculpting,photography,
fashion design, graphic arts, etc):
please specify: ______# yrs: 1-3 / 4-6 / 7-10+
__ Other: ______
If you wish to give details: ______
______
______
School Letters Earned: Please list the following below
The list of sports/academics / arts / etc in which you have lettered and the years you earned this letter.
For example: Basketball, lettered: 2012, 2013, 2014 + (anticipate 2015)
Band: lettered: 2013, 2013, 2014 + (anticipate 2015)
______
______
______
______
You may use a second column if necessary.
The ACCF is experiencing more scholarship access for local students. Many donors are interested in specific student involvement.
This will assist the ACCF and the donors when identifying the student–profile for the scholarship selection committee’s review.
Thank you for your interest.
(end)
4 / 4