UNIVERSAL SCHOLARSHIP APPLICATION
2/15
THIS FORM IS TO BE USED FOR THE FOLLOWING SCHOLARSHIPS:
SONS OF AMERICAN LEGION-SQUADRON #189 (see p. 5)
MILLER'S MERRY MANOR, CINDY HERMAN MEMORIAL SCHOLARSHIP (nursing)
MICHAEL CHARLES ALBERT SCHOLARSHIP FUND
WILLIAM E. NICHOLS CREATIVE ARTS SCHOLARSHIP (art related)
NORTH LIBERTY PTA SCHOLARSHIP
WILMA MARTIN SCHOLARSHIP (Polk Twp. residents; education major)
NORTH LIBERTY CHAMBER OF COMMERCE, CHARLES "CUB" BARE SCHOLARSHIP (essay-see p. 5)
HARRY R. GANSER MEMORIAL SCHOLARSHIP (essay- see p. 6)
WALKERTON AREA CHAMBER OF COMMERCE SCHOLARSHIP (essay-see p. 7)
MATTHEW JAMES MORRIS SCHOLARSHIP (gpa = or > 3.0; essay - see p. 8)
BRYAN VERKLER MEMORIAL SCHOLARSHIP (law enforcement majors; Vincennes University)
KAYLA M. TRAVERSA MEMORIAL SCHOLARSHIP (see p. 9)
CLARK FAMILY MEMORIAL SCHOLARSHIP (see p. 10)
JAMES “JIMBO” HASKINS MEMORIAL SCHOLARSHIP (see p. 11)
WES PTA Scholarship (Former WES student – essay – p. 12)
NORTH LIBERTY ZETA PI TRI KAPPA SCHOLARSHIP (essay – p. 12)
WALKERTON AREA HISTORICAL SOCIETY ~ Joseph L. Lowry Memorial Scholarship (essay – p. 13)
HAROLD C UREY MIDDLE SCHOOL SCHOLARSHIP (essay – p. 14)
ALVIN C. BOISE MEMORIAL SCHOLARSHIP (essay – p. 15)
WALKERTON EPSILON CHI TRI KAPPA SCHOLARSHIP (essay – p. 16)
ALL DEADLINES: APRIL 13, 2015
********************
PLEASE TYPE
NAME
LAST
FIRST
MIDDLE
HOME ADDRESS
STREET OR ROUTE
TELEPHONE
CITY
STATE
DATE OF BIRTH
FATHER
OCCUPATION
EMPLOYER
MOTHER
OCCUPATION
EMPLOYER
OCCUPATION
EMPLOYER
GUARDIAN/STEP PARENT
NUMBER OF BROTHERS & SISTERS LIVING AT HOME?
SCHOOLS WHERE YOU HAVE APPLIED?
1)
I
IN COLLEGE
CHECK IF YOU HAVE BEEN ACCEPTED
2.)
3.)
1
ZIP
WHAT COLLEGE MAJOR DO YOU PLAN TO PURSUE?
ANTICIPATED LENGTH OF PROGRAM OF STUDY?
PERSONAL DATA
DESCRIBE YOUR WORK EXPERIENCE DURING THE PAST FOUR YEARS. INDICATE DATES OF
EMPLOYMENT IN EACH JOB AND APPROXIMATE NUMBER OF HOURS WORKED IN EACH WEEK.
EMPLOYER
POSITION
DATE FROM
DATE TO
HRS PER WK
LIST ALL SCHOOL ACTIVITIES IN WHICH YOU HAVE PARTICIPATED DURING THE PAST FOUR
YEARS (e.g. student council, class board, music, athletics, etc.). LIST ALL COMMUNITY VOLUNTEER
WORK IN WHICH YOU HAVE PARTICIPATED DURING THE PAST FOUR YEARS (e.g. church work,
community organization service, 4-H, etc.) INDICATE ALL SPECIAL AWARDS OR HONORS.
ACTIVITY
SPECIAL
AWARDS OR
HONORS
# OF
YEARS
ACTIVITY
SPECIAL
AWARDS OR
HONORS
# OF
YEARS
**ARE YOU A RESIDENT OF POLK TOWNSHIP?
PLEASE COMPOSE A STATEMENT OF YOUR PLANS AS THEY RELATE TO YOUR EDUCATION AND
CAREER OBJECTIVES AND FUTURE GOALS. THIS ESSAY SHOULD BE APPROXIMATELY 100
WORDS IN LENGTH.
2
PLEASE REPORT ANY UNUSUAL FAMILY OR PERSONAL CIRCUMSTANCES YOU FEEL
WARRANT ATTENTION.
OTHER AWARDS
PLEASE LIST BELOW THE NAME AND AMOUNT OF ANY GRANTS OR SCHOLARSHIPS THAT YOU
HAVE BEEN AWARDED FOR THE COMING SCHOOL YEAR.
NAME OF SCHOLARSHIP OR AWARD
AMOUNT
WHAT DO YOU ANTICIPATE YOUR EXPENSES TO BE FOR A FULL YEAR AT SCHOOL?
HOW WILL YOU FINANCE YOUR COSTS THIS YEAR?
HOW MUCH HAVE YOU SAVED TOWARD YOUR EDUCATION?
DO YOU PLAN ON BEING EMPLOYED DURING COLLEGE/VOCATIONAL SCHOOL?
PLEASE INCLUDE THE FOLLOWING:
1.
A GRADE TRANSCRIPT
2.
A GUIDANCE COUNSELOR INFORMATION SHEET (ATTACHED)
3.
TWO LETTERS OF RECOMMENTDATION. (TEACHERS, COUNSELORS, ADMINISTRATORS,
MINISTERS, AND COMMUNITY MEMBERS ARE ACCEPTABLE)
4.
A PHOTO, IF POSSIBLE
5.
SPECIAL CRITERIA FOR CERTAIN SCHOLARSHIPS (SEE P. 5 - 11)
PHOTO
3
COLLEGE OR VOCATIONAL SCHOLARSHIP
GUIDANCE COUNSELOR REPORT
TO BE FILLED OUT BY THE JOHN GLENN HIGH SCHOOL COUNSELOR
LAST NAME
FIRST NAME
MIDDLE INITIAL
1. HOW LONG HAS THE APPLICANT ATTENDED YOUR SCHOOL?
2.
3. IN WHAT FIELDS HAS THE APPLICANT DONE HIS/HER BEST WORK?
ART
MATHEMATICS
BUSINESS EDUCATION
MUSIC
PHYSICAL EDUCATION/ HEALTH
ENGLISH
FOREIGN LANGUAGE
SCIENCE
INDUSTRIAL TECHNOLOGY
SOCIAL STUDIES
INTERDISCIPLINARY
EDUCATION
AGRICULTURE
HOME ECONOMICS
3. NUMBER IN CLASS:
4. SAT/ACT SCORES: CRIT. READ
APPLICANTS CLASS RANK:
Writing
Skills
MATH
5. HAS THE APPLICANT BEEN SUBJECT TO DISCIPLINARY OR ACADEMIC CENSURE DURING
HIS/HER HIGH SCHOOL STAY FOR DEFECTIVE SCHOLARSHIP OR MISCONDUCT?
DATE:
COUNSELOR
4
ADDITIONAL CRITERIA
**IF APPLYING FOR THE SONS OF THE AMERICAN LEGION PLEASE ANSWER THE
FOLLOWING QUESTION:
"DO YOU OR ANY OF YOUR RELATIVES BELONG TO THE SONS OF THE AMERICAN LEGION,
THE AMERICAN LEGION, OR THE LEGION AUXILIARY?"
PLEASE LIST NAME, RELATIONSHIP, AND ORGANIZATION.
**IF APPLYING FOR THE CHARLES "CUB" BARE SCHOLARSHIP:
PLEASE INCLUDE AN ESSAY OF 250 WORDS OR MORE ON THE FOLLOWING TOPIC (YOU MAY
ATTACH AN ADDITIONAL SHEET.)
"HOW PERSONAL INVOLVEMENT IMPROVES MY LOCAL COMMUNITY."
5
HARRY R. GANSER MEMORIAL SCHOLARSHIP
ESSAY: Your essay for this scholarship should address three areas. Outline your personal, educational,
and career goals. Describe yourself as a leader and what leadership means to you. Finally, discuss the
importance of friendship and what friendship means to you. Your essay should not exceed 500 words.
Please type or print neatly in ink in the space provided below or attach an additional sheet.
6
Walkerton Area Chamber of Commerce Scholarship
The Walkerton Area Chamber of Commerce has a strong belief in community involvement. With that
in mind, please submit an essay of 250 words or more on the following topic:
"How does my present personal involvement affect my community and how will my future
personal involvement in my community affect it, as well?"
7
MATTHEW JAMES MORRIS SCHOLARSHIP
The Matthew James Morris Scholarship was created to honor Matthew’s dream of being the best he could be by
completing a college education. The criteria for this scholarship was determined by Matthew’s view of life and the
beliefs he exemplified. Matthew was a very courageous young man who was not afraid to try anything and gave
everything of himself. He has a golden heart and a sense of integrity that was admired by his peers and adults alike.
He was a very intelligent, but humble, young man. He was not one to judge others and viewed everyone as an equal.
His perseverance stood out because he was determined to better himself, however, not at the expense of others.
Matthew was raised with a strong conviction of values and morals which were instilled in him by this family. These
helped to shape him into a gifted, level headed, spirited young man whose smile will forever be etched in our
memories.
Criteria: John Glenn High School Senior
GPA 3.0 or above
Essay: 500 words – (typed, double-spaced)
Explain what Integrity, Courage, and Perseverance mean to you and how you exemplify them in your life.
8
KAYLA M. TRAVERSA MEMORIAL SCHOLARSHIP
GPA of 2.0 higher
Must be involved in a club, sport, or extracurricular activity.
Please answer the following essay questions. (typed)
1. What have you gained from your experiences here at John Glenn that can help you with your
future plans?
2. Where do you see yourself in ten years?
9
CLARK FAMILY MEMORIAL SCHOLARSHIP
The Walkerton Volunteer Fire Department prides itself on protecting and serving our community.
Our members are family, as well as the citizens we serve.
The Clark Family Scholarship was created to honor Keith, Alice, and Kelsey
and their role in our community.
Essay: 500 words or less
Describe your past and present community involvement. Explain how you plan to continue
community involvement in the future. List and explain some goals after your college education.
10
JAMES “JIMBO” HASKINS MEMORIAL SCHOLARSHIP
In at least 300 words, describe what leadership, friendship,
and community involvement mean to you.
11
WES PTA SCHOLARSHIP ESSAY
In 500 words or less describe who or what at WES has influenced your life and/or helped you
decide your career path.
NORTH LIBERTY ZETA PI TRI KAPPA - ESSAY
Please attach a short autobiography (100 words) to tell a little about your family, school and work
history. Include your community/charity involvement. Then add a statement of your ambitions and
goals.
(You may type your essay in the box below or attach an additional sheet.)
12
WALKERTON AREA HISTORICAL SOCIETY
JOSEPH L. LOWRY MEMORIAL SCHOLARSHIP
Joseph “Joe” L. Lowry was born and raised in the Walkerton area. He taught in South Bend and North Liberty schools for 38
years. He served on the John Glenn School Corporation Board of Trustees from 2002 until his death in 2010. He also
contributed to the success of the John Glenn Building Trades program as an electrical instructor.
Applicants must pursue further education in one of the following occupational fields:
building trades/construction, plumbing, electrical, heating/air conditioning,
or automotive/diesel/farm mechanics.
Answer the following questions in essay form of 500 words or less:
*What area of expertise are you pursuing as you further your education?
*What classes have you taken, skills have you acquired, or life situations have you experienced while
attending John Glenn High School, which will benefit your future life goals?
*Describe a project you have planned or completed that demonstrates your interest or skills as related to
your life goals.
13
Harold C. Urey Middle School Scholarship
Candidates must:
a) successfully complete 8th grade at Urey Middle School
b) have a minimum GPA of 2.500 after 7 high school semesters
c) have been involved in 1 or more extra or co-curricular activities during their career at Urey Middle
School
Please list the extra or co-curricular activity/activities you were involved in while a student at
Urey Middle School:
Please address the following statement in no more than 250 words:
Reflect on 1 weakness that you have worked on since leaving middle school:
14
ALVIN C. BOISE MEMORIAL SCHOLARSHIP
College or Vocational
1958 - 1964
1964 - 1967
1967 - 1970
1970 - 1972
1972 - 1978
1978 - 1982
Agriculture TeacherGuidance Director
Guidance DirectorPrincipalPrincipalGuidance Director-
Tyner High School
Tyner High School
John Glenn High School
Urey Middle School
John Glenn High School
John Glenn High School
Write an essay about a teacher that has influenced you and how they have impacted your decision
to pursue your future career. Include how you feel your future education will allow you to impact
others in a positive way. Essay should not exceed 500 words.
15
WALKERTON EPSILON CHI
TRI KAPPA SCHOLARSHIP
Please prepare a goal statement of approximately 200 words as to why you chose your
particular field of study, what experiences and persons influenced your decision, and your
specific career goals and ambitions.
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