Henrietta Keller, Master

Illinois State Grange Scholarship Application. Please read the material carefully as some of the requirements have changed and make certain all the required information will reach me by the deadline of Friday, February 17, 2017. That means the information needs to be mailed by Friday, February 10th. The completed packet of application information should be sent to me in its entirety, except the Master/President’s recommendation. That should be sent directly to me from the Master/President or other member if parent is Master/President. The applicant must be a Grange member for at least one-year prior scholarship selection on March 25, 2017. The applicant must be present at a Grange meeting/function/activity to accept the scholarship.

The applicant must be enrolled as a full time undergraduate student in a college or university or enrolled in a master’s program. Applications will be evaluated on Academic Performance [35%], School Activities [15%], Community Activities [20%], Grange Activities [20%], Misc. [5%], and Essay [5%]. Misc. is for the neatness, following the directions given, etc. At the Executive Committee meeting in March the decision pertaining to scholarships will be made, notification of the decision will be shortly after. If you have any questions regarding your application, please contact me.

Fraternally,

Enclosures - Informational Guidelines - Scholarship information - Personal information form INFORMATIONAL GUIDELINES

Applicant hereby agrees that the Illinois State Grange Executive Committee, hereafter referred to as the grantor, is to be sole judge in awarding this grant to any person the grantor so chooses. Applicant hereby agrees to repay this grant within 30 days if the applicant does not attend college or vocational school in full-time status in program enrollment for any reason, whatsoever. Applicant further agrees that if this grant is not repaid within 30 days, the prevailing bank interest rate on loans will apply. The 30 days refers from 1 month after the date stated scholarships being awarded, March 25. 2017. Applicant hereby further agrees this grant is to be used for the current academic year. Applicant must furnish current written character references for three (3) separate sources other than parents or relatives, one of which shall be the Subordinate Grange Master/President. If Master/President is relative, another Grange member must complete the form. A separate form, which is to be supplied by the applicant from the IL State Secretary to the Master/President, will be returned to the Secretary from the Master/President. Applicant must furnish one essay, “What would I tell the President of the United State about Grange?” It shall be a minimum of 150 words to a maximum of 250 words. Applicant hereby agrees to return this application and all supporting documentation to the State Secretary by Friday, February 17, 2017. Failure to do so will eliminate applicant’s name from the candidates. Applicant hereby agrees to attend a Grange meeting/function/activity in order to receive the check. Applicant hereby allows the grantor to make any investigation of applicant’s personal and academic history, through any means grantor so chooses, and applicant does not hold the grantor responsible for such actions. Applicant hereby certifies the below facts set forth in the personal information form are true and complete to the best of applicant’s knowledge and any falsification of these facts will cause application to be forfeited. Applicant must be a Grange member for at least one year.

______Date Signature of applicant

Check one - This application is for Horticultural ( ) Agricultural ( ) Nursing ( )

Other ( ) if other name field of study ______Personal Information Form 1. Name of Applicant______2. Address______3. Date of Birth______Phone ______4. Parents’ or Guardian Names (if applicant under 18)______5. List of your employers, if any______6. Name of Grange ______No.______7. Number of years - Subordinate member _____ Junior Member____ 8. Are you a member of 5th ( ) 6th ( ) 7th ( ) degree? 10. Include a listing of your recent (up to 2 years) Grange Activities 11. Name of High School graduated from and year ______12. Cumulative Grade Point Average of the last 3.5 years of education _____/____ (scale [ie 3.5/4.0] ) 13. SAT score_____ ACT _____ 14. Are you a recipient or candidate or have you made application for any other scholarship or grant? Name______15. Name of College of your choice or attending ______

16. Include most recent transcript [an original or copy of an original transcript that is certified or stamped by registrar’s or admission’s office].

17. Include your extra-curricular school, work and community activities in full detail each on separate sheet. If there is limitation in any of these fields please explain reason(s).

18. Include essay answering the following question “What would I tell the President of the United States about Grange?” There shall be a minimum of 150 to maximum of 250 words. This section of the Illinois State Grange Scholarship application is to be completed by the Master/President of the Subordinate Grange of the applicant and returned to the State Grange Secretary prior to Friday, February 17, 2017.

Name of Applicant______

Please send your letter of recommendation include the following information about the applicant:  Attendance at meetings  Offices held  Membership promotion  Ritualism - Degree work  Committee participation  Fund Raising or Community Service  Other Comments

Date______Signature of Master/President/Representative

______

Grange Name & No.______

Notes:______