Mary Margaret Black Scholarship Fund
As a lasting memory to Mary Margaret Black, a Ross County, Ohio resident concerned
about education, an annual scholarship provides funds for college students.
Guidelines for Application
1. Applicant must have a 2.5 grade point average.
2. Applicants may apply from South Central Ohio counties.
3. Applicant must provide proof of acceptance by the college, trade school, or technical
school of his/her choice.
4. Application must be accompanied by official high school transcripts and ACT or
equivalent scores.
5. Scholarship funds are to be used for general expenses: Tuition, room/board, and books.
6. Scholarship payment will be made only to the designated educational institution.
7. Should a student withdraw before completing his/her first year, the remaining funds, in
accordance with the policy of the institution, shall be returned to the fund.
Applications should be returned to your guidance office or by mail or
email to:
Chillicothe-Ross Community Foundation
45 E Main St
Chillicothe, Ohio 45601
mmblack@crcf.net
Mary Margaret Black Scholarship Fund
Application Deadline: March 27, 2015
I hereby apply for a college scholarship and submit the following information.
Tape senior
picture
here.
Name:
Address:
City, State, Zip:
Date of Birth:
Social Security #:
Phone #:
Email Address:
Parent or Guardian: (father/stepfather)
Parent or Guardian: (mother/stepmother)
Number of younger brothers or sisters:
High School Class Rank:
Number of brothers or sisters attending college:
A.C.T. Composite Score:
Name and Address of College, University, or Trade School you plan to attend:
Name of Admissions Officer:
Phone & Extension # of Admissions Officer:
What College, University, or Trade School degree do you currently hope to achieve?
What Career/Field do you wish to enter with this degree?
Attachments
Please include the following attachments:
 Proof of acceptance by the school of your choice
 High school transcript
 Two letters of recommendation from teachers, coaches, advisors, or other community
leaders
 A list of recognition you have received for outstanding schoolwork - i.e. honors, prizes,
or scholarships
 A list of the activities in which you have engaged during your high school years
o Include in the list organized out-of-school activities – i.e. 4-H Club, scouting,
church organizations, etc.
o Also include those activities connected with school – i.e. class officer, music
organizations, athletics, publications, etc.
 Self Expression Synopsis
o Write an essay of at least 250 words, describing yourself; your interests,
hobbies, and goals; and your church, school or community involvement.
 A senior picture (or other picture) if available
Mary Margaret Black Scholarship Fund
Statement of Proposed Budget for the Coming Year
Anticipated Sources of Income
Scholarship/Grants:
$
Loans:
$
Summer Work:
$
Family Contributions:
$
Other:
$
Total Income:
$
Estimated Expenses
Tuition & Fees:
$
Room & Board:
$
Books:
$
Travel Expenses:
$
Miscellaneous Expenses:
$
Total Expenses:
$
Mary Margaret Black Scholarship Fund
I hereby certify that all statements contained in the foregoing application are true and correct,
that I have read the description of the Mary Margaret Black Scholarship Fund, and that I believe
myself eligible to apply for a college scholarship under the provisions and conditions it contains,
and I authorize my school to provide information to the Selection Committee upon request.
Should I receive the scholarship, I authorize my picture to be used in promotional and news
material (including print and internet) concerning the scholarship.
Signed:
Date:
(Student)
This application and certification and release are true and correct and meet with my approval.
Signed:
Date:
(Parent)
Scholarship Application Best Practices
When applying for a scholarship through the Chillicothe-Ross Community Foundation,
we request that you adhere to the following guidelines. Doing so will make the
application review process run smoothly and assist our selection committees with
making timely decisions.

Do not print the application or supplemental documents in a two-sided format.

Do not use a report folder.

Type essay.

Do not staple any portion of the application or supplemental documents. Use
paperclips only.

Do not fold the application.

Use standard 8 ½ x 11 paper to print all application pages as well as
supplemental documents.

Tape a wallet-size picture in the place indicated on the front of the application.

Write your name on the back of your picture.

All answers should be typed if possible. To do this, open the application in a
word processor and type in the spaces. If typing is not possible, please print
legibly.