INDEPENDENT INSURANCE AGENTS OF AUSTIN SCHOLARSHIP INFORMATION

Qualifications: The Independent Insurance Agents of Austin scholarship will be awarded based on the following criteria: . Academic Achievement . Financial Need . Extracurricular Activity . Community Involvement . The students’ statements regarding expected academic major.

The applicant must meet the following requirements: . Have a parent that works for a member agency for the Independent Insurance Agents of Austin or be an intern working for a member agency for the Independent Insurance Agents of Austin. A letter of recommendation from the employer will also be required for interns that are applying. Please be sure to attach the letter to your application when you apply if you applying as an intern. . Prefer an insurance or finance major but other majors will be considered . Must be attending a 4 year college . Must be attending a public, state or private college or university for 2018-2019 school year (junior colleges not acceptable). . Must be a graduating high school senior or a current college student for the 2017-2018 school year that resides in Travis County or a contiguous county.

Scholarship Offered: . (1) $5,000 general scholarship

Application Process and Deadlines: . To apply, please fill out the application form below completely. . The application must be received March 1, 2018. No applications can be accepted after that date. . Scholarships recipients will be notified by March 31, 2018. . Scholarships will be awarded at the Independent Insurance Agents of Austin luncheon on May 9, 2018. Scholarship winner is expected to be in attendance at this luncheon. . IIAAustin reserves the right to change information as needed.

Questions: Kim Kieschnick Executive Director Independent Insurance Agents of Austin P.O. Box 28226 Austin, TX 78755 Phone: 512.401.6412 Email: [email protected] 1 INDEPENDENT INSURANCE AGENTS OF AUSTIN SCHOLARSHIP APPLICATION

Full Name:

Home Address:

Phone:______Email Address: ______

Age:______Birth Date (mm/dd/yyyy):______Gender (M/F): ______

HS Graduation Class of:______High School: ______

Class rank: ______out of ______students. SAT score:______ACT score: ______

Father’s Name and Occupation:

Name of IIAAustin member agency* where father works if applicable:

Mother’s Name and Occupation:

Name of IIAAustin member agency* where mother works if applicable:

*If you are unsure if your agency is a member of IIAAustin, please contact Kim Kieschnick.

Annual income of both parents from last year’s income tax: Year:______Total $: ______

Please list other means that have been set aside for you to attend college. (Example: Texas Tomorrow Fund, Savings Account, etc.):

What percentage of help do you anticipate your family giving you for college?

Are you a current college student (circle one)? Yes † No 2 If yes, where are you currently attending college?

What is your current GPA?

Will you be still be attending this same college for the 2018-2019 school year (circle one)?

Yes † No

If no, where will you be attending college for the 2018-2019 school year?______

______Please include a copy of your acceptance letter.

If you are not a current college student, will you be a graduating high school senior for 2017-2018 school year (circle one)? Yes † No

If yes, which college or colleges have you applied to:

Please include a copy of your acceptance letter(s) with this application.

List jobs you have held or work done while in high school and/or college (if more space is needed, complete on separate sheet):

Employer Type of Work Starting/Ending Date 1. 2. 3. 4.

What honors or awards have you received (school related/non‐school related):

List high school and/or college activities and organizations you have participated in:

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List activities and organizations outside of school:

What is your expected major in college?

What are your professional or vocational objectives?

Briefly explain why you have chosen your college major and objectives:

Please add any additional information you would think would be helpful to the scholarship committee:

4 If selected the Independent Insurance Agents of Austin may publicly disclose and . publicize the non-financial information in this application (e.g., grades, class standing,

extracurricular activities, etc.). I have read the Qualifications listed for this scholarship application as shown on page 1. . I certify that the information in this application is true, correct, and complete to the best . of my knowledge.

Include the following with your application:

. A picture of yourself that we can use for promotional purposes if chosen for the scholarship. You can email a jpg to [email protected] . . A ttach a copy of your college acceptance letter(s). . I f you are an intern working in a member agency for the Independent Insurance Agents of Austin, please be sure to include a letter of recommendation from your employer.

Applicants Signature:

Date:

Parent’s or Guardian’s Signature:

Date:

Mail Completed Applications To: Kim Kieschnick Executive Director Independent Insurance Agents of Austin P.O. Box 28226 Austin, TX 78755

You may also scan and email your application to: [email protected] .

APPLICATIONS MUST BE RECEIV E D BY MARCH 1, 2018.

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