2015-2016
General Scholarship Application Form
Applicant Name:
First Name
Middle Name
Last Name
This application is for all Lebanon Educational Foundation scholarships for Lebanon High School senior students. You only need to
submit this one application for any/all Lebanon Educational Foundation scholarships for which you are applying. The Lebanon
Educational Foundation Scholarship Application is due to the Lebanon High School Guidance Office by 3:00 p.m. on Friday,
February 5, 2016. Contact the LHS Guidance Office or the Lebanon Educational Foundation at 482-1185 or lef@leb.k12.in.us if you
have any questions.
PLEASE COMPLETE THE FOLLOWING:
1.
Verify that you are eligible for the scholarship(s) listed below by reviewing the criteria located on the Foundation’s website
at www.lebanonlef.org or in the LHS Guidance Office.
2.
Mark the box for each scholarship listed below for which you are applying.
3.
Print and sign the next page (page 2) and have your parent/guardian sign the next page.
4.
Complete the remaining application; submit the entire application to the guidance department by 3:00 p.m. February 6, 2015.
Bob Hawkins Law Enforcement Scholarship – Must plan to major in law enforcement or be the child of a member of the law enforcement
and have a GPA of 2.5.
Boone REMC Community Fund, Inc. Operation Round Up Scholarship – Must attend a vocational/technical school to be eligible.
Carol Belles Music Memorial Scholarship – Must have 3 years of choir or band to be eligible.
Brad Gustin Memorial Swimming Scholarship – The recipients must display good citizenship and will be selected by a vote of the swim
team members.
Cheryl Ann Cowan Memorial Scholarship – Must plan to major in Elementary Education to be eligible.
Denise McLaughlin Memorial Scholarship – Must have a GPA of 3.0 to be eligible. The applicant must complete an essay about
Community Service, “What have you done to make your community a better place to live?”.
Denger Family Scholarship – Must have a “B” average to be eligible.
Edward Jones Scholarship – Must have a minimum weighted GPA of 3.5 or higher.
FFA Alumni Scholarship – Must have actively participated in FFA for a minimum of three years. The student must complete the FFA
Student Involvement form which must be attached to the LEF Scholarship Application
James Rosenstihl Memorial Basketball Scholarship – Must be a member of the boys or girls basketball team.
John Isenhower Memorial Scholarship – Must have played an LHS sport for at least two years to be eligible.
Jones/Hays Jones Scholarship – Must submit an essay on “Why is giving back to your community important? What can you do in the
future to give back to your community?” Student must have a 3.0 GPA or higher.
K.C. Kays Memorial Scholarship – Must attend a university or technical school to study aviation to be eligible. The applicant must
complete a 1,000 word essay on the subject: “The Sacrifices Necessary to Keep America Free.”
Keith Norton Memorial Scholarship - Recipient must be in the top 25% of graduating class, plan to major in engineering and attend a 4year college or university.
Kiwanis Club of Lebanon Scholarship - Must have participated in service to the community.
LEF Scholarship – Must have a “B” average to be eligible.
Lucas E. Keesee Memorial Scholarship – Must participate as a senior in a LHS sport and organization to be eligible.
Marilyn Suzanne Kern Memorial Scholarship – Must maintain a B average and attend Purdue University.
Morgan Allen Memorial Scholarship – Must have participated in the Graduation Coaching Program for at least 2 years and have a
GPA of 2.0 or higher.
NorthPark Community Credit Union Scholarship – Must have a GPA of 3.0 or higher; plan to study Business, Finance or Accounting.
Obremskey Family Scholarship – Must attend Indiana University and be in the top 20% of the graduating class.
Pliny and Mildred Randall – Must plan to attend a 4 year college or university and be in the top one-third of class.
Ralph Wortman Memorial Scholarship – Past member and volunteer of the Lebanon Area Boys and Girls Club and provide documentation
with the application that they have volunteered at the Lebanon Area Boys and Girls Club. An essay on the impact the club has had on the
student is also required.
Richard and Donna Linton Memorial Scholarship – Minimum “B” average or better and desire to become a business owner.
Roy Flanary Tennis Scholarship (Boy) – Must have been a member of the tennis team for a minimum of 2 years
Roy Flanary Tennis Scholarship (Girl) – Must have been a member of the tennis team for a minimum of 2 years.
Sam Herr Memorial Scholarship – Must have maintained a “C” average or above and plan to study agriculture.
State Bank of Lizton Scholarship – Recipient must plan to attend a 4-yr college/university in Indiana and major in business. Based on need
and academic performance as determined by the Foundation.
Tiger Merit Scholarship – Must be in the top one-third of the class; exemplify good citizenship and scholastic excellence.
VFW Post #910 Men’s Auxiliary – Recipient must be accepted to a two or four year college or university and have a GPA of 3.0 or higher.
Must submit an essay entitled “What does Patriotism Mean to Me?”.
Katie A. Brown Memorial Scholarship – The recipient must be a female member of the senior class with a 3.5 GPA and plan to major in a
science-related field of study. She must be active in the community and must have participated in at least one athletic program each of her
four years at Lebanon High School.
LEF 25th Anniversary Scholarship – Student may attend any post-secondary form of education and must have a GPA of 3.0. This may
include trade/vocational school, apprentice school, or a traditional 2 or 4 year college.
1
Assurances:
By signing below, both the applicant and the parent/guardian acknowledge that scholarship payments will be used only for fees for the
institution where the applicant is enrolled and that an invoice from the institution stating the amounts due for each semester will be
provided to the Lebanon Educational Foundation as soon as it becomes available.
As the scholarship applicant, I hereby state that the information submitted with this application is correct to the best of my knowledge
and belief, and that all essay answers are of my own composition, prepared and written by me.
SIGNED: ___________________________________
DATE: ___________________
As the parent/guardian for the above applicant, I approve of his/her application for the above scholarships identified.
SIGNED: ____________________________________
LHS Guidance Counselor’s Signature:
DATE: ____________________
Date:
2
2015-2016
Application Form
Please submit completed application to LHS Guidance Office by 3:00 p.m. on Friday, February 5, 2016. Your
high school counselor will attach a Counselor Page, which includes your GPA, Rank, SAT, and/or ACT scores
and a copy of your transcript to your application before submitting it to the Lebanon Educational Foundation.
Feel free to contact your counselor with any questions.
Applicant Name:
First Name
Middle Name
Last Name
Address:
Street
City
Home or Cell Phone:
(
)
State
Age:
-
Zip Code
Date of Birth:
Area Code
Email Address:
@
Father/Guardian:
# of Dependents:
First Name
Last Name
Address:
Street
City
Home or Cell Phone:
(
)
State
Work Phone:
-
(
)
Zip Code
-
Area Code
Employer:
Company
Position
Mother/Guardian:
# of Dependents:
First Name
Last Name
Address:
Street
City
Home or Cell Phone:
(
)
-
State
Work Phone:
(
)
Zip Code
-
Area Code
Employer:
Company
Position
3
2015-2016
Application Form
Please list the Post Secondary Schools to which you have applied or have been accepted:
First Choice:
Name of Post Secondary School
Location
Tuition amount per semester
Applied or Accepted
Location
Tuition amount per semester
Applied or Accepted
Location
Tuition amount per semester
Applied or Accepted
Second Choice:
Name of Post Secondary School
Third Choice:
Name of Post Secondary School
Intended College Major:
Please list employment you have held while in high school.
Place of Employment
Dates of Employment
Ave. #Hrs. per Week
Use of Income
Please complete the following three questions. Write one page or less for each
question.
1. If you had the authority to change your school in a positive way, what specific changes would you make?
2. Besides your parents, who has been the biggest influence in your life and why?
3. Describe the most significant academic or personal challenge you have faced, the steps you have taken to
address this challenge, and what you have learned about yourself through the experience.
4
Circle the years you participated in the
academic, athletic or extra-curricular
activity.
Place an “X” in the box if you were a
club officer or team captain.
Extra Curricular Activity
Point
Value
Athletic Team
1.
2 pts.
9
10
11
12
2.
2 pts.
9
10
11
12
3.
2 pts.
9
10
11
12
4.
2 pts.
9
10
11
12
5.
2 pts.
9
10
11
12
6.
2 pts.
9
10
11
12
Athletic Team Manager (List the Sports You Managed.)
1.
1 pts.
9
10
11
12
2.
1 pts.
9
10
11
12
3.
1 pts.
9
10
11
12
Athletic Letter Winner (List Sports You Lettered In.)
1.
2 pts.
9
10
11
12
2.
2 pts.
9
10
11
12
3.
2 pts.
9
10
11
12
4.
2 pts.
9
10
11
12
5.
2 pts.
9
10
11
12
6.
2 pts.
9
10
11
12
Senior Class Officer
2 pts.
12
Junior Class Officer
2 pts.
11
Sophomore Class Officer
2 pts.
10
Freshman Class Officer
2 pts.
Student Council
2 pts.
9
10
11
12
Cheerleader
2 pts.
9
10
11
12
Key Club
2 pts.
9
10
11
12
Z-Club
2 pts.
9
10
11
12
Sunshine Society
1 pt.
9
10
11
12
Academic Teams
1.
2 pts.
9
10
11
12
2.
2 pts.
9
10
11
12
3.
2 pts.
9
10
11
12
National Honor Society
2 pts.
11
12
Spell Bowl
2 pts.
9
10
11
12
Brain Game
2 pts.
9
10
11
12
Three or more honors classes (list the classes)
1.
2 pts.
9
10
11
12
2.
2 pts.
9
10
11
12
3.
2 pts.
9
10
11
12
4.
2 pts.
9
10
11
12
5.
2 pts.
9
10
11
12
6.
2 pts.
9
10
11
12
FCA
1 pt.
9
10
11
12
FFA
2 pts.
9
10
11
12
Foreign Language Club
1 pt.
9
10
11
12
Tiger Tenders
1 pt.
9
10
11
12
Tiger Leadership Camp
1 pt.
School Musicals
2 pts.
9
10
11
12
School Plays
2 pts.
9
10
11
12
Stage Crew
1 pt.
9
10
11
12
Pep Band
1 pt.
9
10
11
12
9
10
11
Letter Winner
Yes
No
Letter Winner
Yes
No
12
5
Marching Band
1 pt.
9
10
11
12
Flag Corps
1 pt.
9
10
11
12
Madrigals
1 pt.
9
10
11
12
Charisma
1 pt.
9
10
11
12
Yearbook staff
1 pt.
11
12
Newspaper Staff
1 pt.
11
12
Tiger X Club
1 pts.
9
10
11
12
1 pt.
9
10
11
12
1 pt.
9
10
11
12
1 pt.
9
10
11
12
1 pt.
9
10
11
12
1 pt.
9
10
11
12
1 pt.
9
10
11
12
1 pt.
9
10
11
12
1 pt.
9
10
11
12
1 pt.
9
10
11
12
1 pt.
9
10
11
12
Letter Winner
Yes
No
Other activities and honors:
6