Insurance Management Service
Scholarship
Please return application to:
BERRIEN COMMUNITY FOUNDATION
2900 South State Street, Suite 2 East
St. Joseph, MI 49085
Attn.: BCF Scholarship
Insurance Management Services
Scholarship
The IMS Scholarship is administered by the Berrien Community Foundation
Application Instructions
Before preparing this application, please review the criteria outlined below.
The application and all support material must be submitted or postmarked by March 6, 2017.
The application MUST be typed, no staples. Please do not put the completed application package in any type of binder. Simply paper clip pages in upper left hand corner. It must be postmarked by a post office. Incomplete applications will not be considered.
Scholarship Purpose: This scholarship was established by Insurance Management Service to encourage success in furthering his education for a deserving Benton Harbor High School graduating senior who was also a member of the Benton Harbor High School football team.
Scholarship Criteria: This is a renewable scholarship for individuals meeting the following criteria: 2.6 or above GPA, Benton Harbor High School graduating senior who also participated in Benton Harbor high school football their senior year. This scholarship may be used at a U.S. vocational technical/ institute school or college/university (2-4 year schools) for tuition, books, fees, and other costs related to attending, but not for room and board. The scholarship may be deferred for future years of undergraduate education as needed.
To complete your application, provide the following in order:
Signed Application
A 250 word essay on how high school football has made you a better person.
High school transcript, and if not included on this transcript, ACT or SAT transcript
Evidence of financial need. A copy of FAFSA Determination Letter with Estimated Expected Family Contribution.
If you have any questions, email or call (269) 983-3304 x 4. School counselors will be notified by the Foundation in May regarding the scholarship recipient(s). In mid-May, scholarship recipients will receive invitations to the Foundation’s scholarship event in June where certificates will be presented. Information on how to access the scholarship will be sent to recipients by the end of June. The scholarship will be paid directly to the college/university on the student's behalf by early September, if this information is provided.
Return the completed application and all support material to:
Berrien Community Foundation
Scholarships
2900 S. State Street, Suite 2 East
St. Joseph, MI 49085
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Insurance Management Service Scholarship Application
Applicant Information – Must Be Typed
Name: Click here to enter text.
Address: Click here to enter text.
City: Click here to enter text.State: Zip:
Primary Phone: Click here to enter text. Cell Phone: Click here to enter text.
Email: Click here to enter text. Date of Birth (mm/dd/yyyy):
Are you a U.S. Citizen? ☐Yes ☐No (proof of citizenship or authorization to be in the U.S. will be required, if a scholarship is awarded)
If not a U.S. citizen, what type of visa do you hold? Click here to enter text.
Name of Parents/Guardian: Click here to enter text.
Phone Number: Click here to enter text.
High School Information:
High School: Click here to enter text.
GPA: Click here to enter text.ACT or SAT Score: Click here to enter text.
Counselor: Click here to enter text.Phone: Click here to enter text.
Counselor Email: Click here to enter text.
Graduation Date (mm/dd/yyyy):
School Awards Ceremony – include date and time:
Scholarship Celebration Availability
(Please note, failure to attend may result in loss of scholarship.)
Are you available to attend the Scholarship Celebration on June 22, 2017? Yes ☐No ☐
College/ University Information
List the U.S. schools to which you have applied for admission in order of preference:
1. Click here to enter text. Were you accepted? Yes ☐No ☐Pending ☐
2. Click here to enter text. Were you accepted? Yes ☐No ☐Pending ☐
3. Click here to enter text. Were you accepted? Yes ☐No ☐Pending ☐
Activities
Using the space below, begin by listing information about your years playing Benton Harbor Football. Next, list activities related to education (e.g., Honor Society), other athletics (e.g., sports and roles), good citizenship (e.g., volunteer activities), leadership (e.g., leadership positions, training), and excellence (e.g., awards, recognition) in which you have participated during the past four years. Please list the activities in order of importance to you. You may attach one page of additional information if necessary.
Organization / # of Years / Leadership Position, Awards and RecognitionBenton Harbor High School Football Team(must have participated at least Senior Year) / Click here to enter text. /
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Signatures Cannot be electronic signatures. Must submit a signed hard copy.
Certification:
I acknowledge that the information in this application is correct to the best of my knowledge. I fully understand that if an award is given to me, it is for the purpose of post-high school education. In the event that I do not enter a post-high school program, terminate the program prior to using the award, or receive other financial assistance (Pell grants, scholarships, tuition grants, etc.) that cover, in its entirety, any tuition, room and board, or class material costs, I will relinquish claim to the award in order that it might be given to another student. I also acknowledge that distribution of all scholarships is contingent upon funds available.
This scholarship, like all scholarships awarded through the Berrien Community Foundation, is made at the discretion of the Board of Trustees. The Berrien Community Foundation Board of Trustees reserves the right to rescind any or all of this scholarship due to unanticipated circumstances.
Signature of Applicant: ______Date: ____/____/____
Permission to Release Information:
We accept the terms of this scholarship program and permission is granted to the Berrien Community Foundation to seek verification of any information provided in this application from any source, for review by the officers and trustees of the Foundation or any other person authorized by the Foundation. We hereby release from liability any person submitting information to the Foundation for use in the selection of scholarship recipients.
Signature of Applicant: ______Date: ____/____/____
Parent’s or Guardian’s Signature: ______Date: ____/____/____
Return this completed form and all support material to:
BCF Scholarships
Berrien Community Foundation
2900 S. State Street, Suite 2 East
St. Joseph, MI 49085
Phone: 269-983-3304 x 4
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