Scholarship Application
for Non-traditional Students
(student has graduated from high school or GED program)
The scholarship awarded to the person(s) selected by the Scholarship Selection Committee will
be granted as support for qualified school expenses incurred during the course of study that
will lead to a certification, associate degree, or a baccalaureate degree at any accredited school,
college, or university.
Please check ALL the scholarships for which you might be eligible. You may contact the
Foundation to verify eligibility.
Fountain / Warren VFW Post 3318 Men’s Auxiliary Scholarship:
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Must be a resident of the Attica Consolidated School District or the Metropolitan School District of
Warren County for at least one year.
Must be accepted to pursue a course of study at an accredited vocational school, technical school, or
college/university.
Must have a high school diploma or GED.
Priority will be given to applicants that display financial need.
Gilbert Bailiff Memorial Scholarship:
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Must be a resident of Warren County for at least 12 months and have graduated from Seeger High School
or GED program.
Must be accepted to an accredited vocational school or technical school. (example Lincoln Tech)
Miss Beason Scholarship:
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Must be a resident of Warren County for at least 12 months and have graduated from Seeger High School.
Must have successfully completed one semester at any accredited college or university in the field of
education.
 This scholarship is renewable.
 Priority will be given to students pursuing an Elementary Education Degree.
 A College transcript must accompany this application if applicable.
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Original Warren County Ambulance Service, Inc. Health Care Scholarship: (please complete a
required one-page budget noting expenses (tuition, fees, books, housing, food, transportation, personal
expenses), the total amount needed for each expense and the source of income to pay the expenses (parents,
savings, work, loans, etc.)
 Must be a resident of Warren County for at least 12 months and have graduated from any high school or
GED program.
 Must be enrolled in a human health related field in either as associate or baccalaureate degree program.
 This scholarship is renewable and can be applied for during the course of any year of studies. Complete
the Request for Renewal Application if applicable.
 A College transcript must accompany this application if applicable.
Rozell-Kerr-Woodhall Memorial Scholarship: (Attica High School)
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Must have graduated from Attica High School and have completed one semester of studies at a college or
university.
A College transcript must accompany this application if applicable.
Preference will be given to students who work while attending college.
This scholarship is renewable and can be applied for during the course of any year of studies. Complete
the Request for Renewal Application if applicable.
St. Vincent Williamsport Hospital Guild Scholarship: : (please complete a required one-page budget
noting expenses (tuition, fees, books, housing, food, transportation, personal expenses), the total amount
needed for each expense and the source of income to pay the expenses (parents, savings, work, loans, etc.)
 Must be a resident of Fountain or Warren County pursuing a degree in Nursing or a health related field.
 Applicants must be a St. Vincent Williamsport Hospital associate who wishes to further their education in
a health related field, or a current freshman in college pursuing a 4-year health related degree.
 Must have a minimum GPA of 2.5. A College transcript must accompany this application if applicable.
 This scholarship is renewable and can be applied for during the course of any year of studies. Complete
the Request for Renewal Application if applicable.
Susie Glaze Nursing Scholarship:
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Must be a resident of Warren County for at least 12 months and have graduated from Seeger High School.
Preference will be given to those that have completed the Health Careers course in high school.
Must be accepted to an accredited public or private college or university to pursue a course of study in
nursing to obtain a RN degree.
Certification
I hereby affirm that the information provided in this application is accurate and complete to the
best of my knowledge. I agree to give proof of the financial need that I have provided on this
application. I give my consent for the personal references to provide information for
consideration in the selection process. To assist with the processing of my scholarship
payments each semester or quarter and to avoid late fees, I will immediately forward to the
Warren County Community Foundation all invoices received for the tuition and any eligible fees
that may be covered by my scholarship.
Applicant’s Signature:
Date:
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Non-traditional Scholarship Application
Applicant Information
Name:
(Last, First, Middle)
Permanent Address:
Date of Birth
Male:
Female:
(Month/Day/Year):
Telephone:
Email:
School District Currently Residing:
Name of High School
Graduation Date:
or GED Program:
Family and Financial Information (Provide as applicable)
Are you married, single, or divorced?:
Total Family Income :
Number of People Residing at Home:
Current Financial Assistance :
Number of Children in Family 18 Years and Younger Residing at Home:
Are you eligible for veteran educational benefits?:
Please Explain Any Financial Hardships:
College/University Information
You have applied to/been accepted by:
Will you be a full time student?
Major field of study:
Length of Course:
Certification or Degree Received Upon
Completion of Course :
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Activities
Using only the space provided below, please record your activities. List them in order of importance to you.
Community Activities (clubs or organizations.)
Service to others (volunteer work – coaching… )
Hobbies
Interests
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Work Experience
In the space provided below, please list paid work experiences (including self-employment) during the past four
years. Please include any supervisory positions held.
Employer
Position/Title
Dates of Employment
Skills
Position/Title
Dates of Employment
Skills
Position/Title
Dates of Employment
Skills
Position/Title
Dates of Employment
Reason for Leaving
Employer
Reason for Leaving
Employer
Reason for Leaving
Employer
Skills
Reason for Leaving
Additional Information:
In the space provided below, please tell the Selection Committee why you are deserving of this scholarship.
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Recipient’s Responsibilities
“If I receive this scholarship, it is my intent to pursue a course of study leading to a certification, associate degree,
or baccalaureate degree.”
“I understand that I am expected to maintain good citizenship qualities. If my behavior continually reflects poor
choices, I understand that my scholarship may be withdrawn.”
“I will submit to the WCCF a copy of my official transcript for each term supported by the scholarship. I will also
keep WCCF advised of any address change.”
(The recipient may forfeit his or her scholarship for failure to comply with the above listed responsibilities.)
Applicant’s Signature:
Date:
If you have any questions regarding this scholarship application, please contact:
Warren County Community Foundation, Inc.
31 N. Monroe St.
Williamsport, IN 47993
765-764-1501
warrencountyfoundation@yahoo.com
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Recommendation Form
Non-traditional Scholarship
To the student applicant: Please complete the top section of this recommendation form
and provide one copy to each individual from whom you are requesting a recommendation.
Full Name
Last
First
Middle
Permanent Address
Number & Street
City
State
Zip Code
Phone
To the person providing the recommendation: Please complete this section and return it to
the student in a sealed envelope. If the seal is broken, the recommendation will be invalid.
I have known the applicant for ______ years in my capacity as _______________________________.
Please rate the applicant in comparison with other students at the same level.
A. Honesty, Integrity
B. Level of Personal Motivation
C. Ability to analyze ideas
D. Oral English expression skills
E. Written English expression skills
F. Demonstrated leadership ability
G. Dependability
H. Respected/liked by peers
No Basis for
Judgment
0
0
0
0
0
0
0
0
Below
Average
1
1
1
1
1
1
1
1
Average
2
2
2
2
2
2
2
2
Above
Average
3
3
3
3
3
3
3
3
Exceptional
4
4
4
4
4
4
4
4
If you feel this student possesses any exceptional characteristics, you may note them below.
Respondent’s Signature
Date
Telephone Number
Type or Print Name
Title/Position
Email Address
Please return this completed Recommendation Form to the applicant in a sealed envelope. If the envelope seal
is “broken”, the Recommendation will be rendered invalid. Please Contact the Warren County Community
Foundation at 764-1501 with any questions.
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Recommendation Form
Non-traditional Scholarship
To the student applicant: Please complete the top section of this recommendation form
and provide one copy to each individual from whom you are requesting a recommendation.
Full Name
Last
First
Middle
Permanent Address
Number & Street
City
State
Zip Code
Phone
To the person providing the recommendation: Please complete this section and return it to
the student in a sealed envelope. If the seal is broken, the recommendation will be invalid.
I have known the applicant for ______ years in my capacity as _______________________________.
Please rate the applicant in comparison with other students at the same level.
A. Honesty, Integrity
B. Level of Personal Motivation
C. Ability to analyze ideas
D. Oral English expression skills
E. Written English expression skills
F. Demonstrated leadership ability
G. Dependability
H. Respected/liked by peers
No Basis for
Judgment
0
0
0
0
0
0
0
0
Below
Average
1
1
1
1
1
1
1
1
Average
2
2
2
2
2
2
2
2
Above
Average
3
3
3
3
3
3
3
3
Exceptional
4
4
4
4
4
4
4
4
If you feel this student possesses any exceptional characteristics, you may note them below.
Respondent’s Signature
Date
Telephone Number
Type or Print Name
Title/Position
Email Address
Please return this completed Recommendation Form to the applicant in a sealed envelope. If the envelope seal
is “broken”, the Recommendation will be rendered invalid. Please Contact the Warren County Community
Foundation at 764-1501 with any questions.
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