Lilly Endowment Community Scholarship Program

offered through the

Franklin County Community Foundation, Inc.

Providing scholarships to prospective college attendees possessing demonstrated character, academic and leadership skills to improve the Franklin County Community.

• THE DEADLINE FOR THIS APPLICATION IS 4PM ON TUESDAY, SEPTEMBER 5, 2017 AT THE FCCF OFFICE, 527 MAIN STREET, BROOKVILLE. Thanks to the generosity of Lilly Endowment Inc., one four-year college tuition scholarship is offered this year to Franklin County residents through the Franklin County Community Foundation. The primary purposes of the Lilly Endowment Community Scholarship Program are to help raise the level of educational attainment in Indiana, to increase aware- ness of the beneficial roles Indiana community foundations can play in their communities and to encourage and sup- port the efforts of current and past Lilly Endowment Community Scholars to engage with each other and with Indi- ana business, governmental, educational, nonprofit and civic leaders to improve the quality of life in Indiana generally and in local communities throughout the state. The scholarship is an honor, as recipients are known as Lilly Endowment Community Scholars. Since the inception in 1998, 33 students have been named. They include: Jackie Betsch, Angel Bruns, David Buchta, Katie Burger, Regina Day, Justin Deutsch, Alex Dudley, Brandi Eastham, Brandon Euen, Kristina Giesting, Caleb Grubb, Mike Hoeing, Kayla Hsu, Ky- lene Kaiser, August Kunkel, Andrea Meyer, Allen Meyers, Alicia Munchel, Mitchell Pepper, Kristina Pittman, Ashlie Raible, Susan Ritzi, Amber Ross, Michelle Sams, Molly Schwab, Elizabeth Simmermeyer, Heather Sottong, Curtis Ward, Brad Wendel, Michael Wessel, Erin Willhelm, Katie Wolber and Luke Wukusick. The program provides: One scholarship for otherwise unreimbursed full tuition, required fees and a special allocation of up to $900 per year for required books and required equipment for four years of undergraduate study on a full time basis, leading to a baccalaureate degree at any Indiana public or private nonprofit college or university accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools. A student’s eligibility for other scholarship assistance (such as participation in Indiana’s Twenty-First Century Scholars Program) shall not be a basis for excluding the student from eligibility, nomination or selection for a scholarship under the Lilly Endowment Community Scholarship Program. When recipients receive additional scholarships, those additional scholarships will be reviewed in order to en- sure that each Lilly Scholar receives the full scholarship amount(s) that are due. The amount awarded under the LECSP may be adjusted to avoid having a scholar’s total award package exceed the Cost of Attendance (according to the Higher Education Act, Sec. 472, http://ifap.ed.gov/sfahandbooks/attachments/0607Vo13Ch2.pdf). Independent Colleges of Indiana (ICI) will receive and invest grant funds, approve nomination criteria and procedures, make final scholarship selections, make the appropriate scholarship payments to the selected colleges and universities, distribute administrative grants to community foundations and book and equipment allocations to scholars and provide administrative services for the Lilly Endow- ment Community Scholarship Program. Lilly Endowment has established the following general criteria for its Lilly Endowment Community Scholarship Program. The program is open to all Indiana residents who: * graduate from an accredited Indiana high school by 2018 and receive their diploma no later than June 30, 2018. A high school is considered accredited for purposes of the program if it is accredited by the State Board of Education or by a national or regional accreditation agency that is recognized by the State Board of Education; * intend to pursue a full-time baccalaureate course of study at an accredited public or private nonprofit college or university in Indiana accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools; * must be completely free to choose which Indiana College he/she would like to attend to pursue a baccalaureate degree. In addition to the requirements set by Lilly Endowment, the Franklin County Community Foundation has established additional criteria for recipients: • must be a resident of Franklin County who is not applying for a Lilly Endowment Community Scholarship from any other community foundation; • must have a GPA of 3.5 or higher on a 4.0 point scale; • must be willing to represent Franklin County and the Franklin County Community Foundation in a positive manner. SELECTION PROCESS • DEADLINE FOR APPLICATION IS 4PM ON TUESDAY, SEPTEMBER 5, 2017 AT THE FCCF OFFICE, 527 MAIN STREET, BROOKVILLE. *PLEASE NOTE: Late applications and recommendations (received after September 5, 2017) will not be considered by the selection committee. To the parents, guardians and students regarding this scholarship application: Please be assured that all information will be treated with the strictest confidence. A Selection Advisory Committee will review all applications turned in by the September 5, 2017 deadline. The Com- mittee will interview three semi-finalists Sunday, October 15, 2017. The applicant chosen to be Franklin County’s 2018 Lilly Endowment Community Scholar will be informed as soon as possible. The FCCF’s Lilly Endowment Scholarship Selection Committee is an independent committee of five members. The FCCF Executive Director acts as a liaison between the FCCF Board of Directors, the FCCF Lilly Endowment Scholarship Selection Committee, ICI, applicants and Lilly Endowment Inc. The Executive Director and Office Manager are not involved in the decision-making process. The committee is chosen to represent a cross-section of Franklin County, including its pro- fessional and geographic constituents. Members have been selected because they are perceived as well respected and objective.

INSTRUCTIONS FOR COMPLETION OF THE APPLICATION FORM

Use the following checklist to be sure you have included all the information necessary to be considered for the scholarship.

_____ Complete the application. Print two entire applications and place them flat (not folded) in a large envelope. Please use paper clips. NO STAPLES. Deliver the envelope to the FCCF office by 4pm on September 5, 2017.

_____ Give copies of the applicant appraisal to three adults. Ask them to complete the forms and insert into an envelope with a signature across the seal. Include the appraisals with your application or mail to the FCCF office by September 5, 2017. If necessary, FCCF will photocopy the applicant appraisals.

_____ Give your counselor the Request for Transcript and Recommendation form. He/She will forward your transcript to the Foundation or he/she will give the request for transcript and recommendation form and transcript to you and you may include them with your packet. If you have included these in your packet, please make a photocopy of both.

_____ If you would like to add more information for any question, you are welcome to attach pages to this application.

APPLICANT SUMMARY The applicant will be scored on the following criteria.

PHASE I- Application (selection committee will not Weight School, community and work experience see applicant’s name during phase I) Criteria #6: Letters of Recommendation Criteria #1: Academic Record Measurement: 10 points Measurement: 5 points Weight: GPA on a 4.0 scale 3.5 - 5 points 3.7 - 7 points 3.9 - 9 points Criteria #7: Essay Originality Measurement: 10 points 3.6 - 6 points 3.8 - 8 points 4.0 - 10 points Weight: Course Difficulty Measurement : 5 points

Criteria #2: Honors Measurement: 15 points Weight: National Honor Society & Awards (Academic, community, athletic and/or work) PHASE II – Interview (face to face with selection committee) Criteria #3: Leadership Measurement: 15 points Criteria #1: Appearance Measurement: 20 points Weight: Demonstrated leadership in academics, Weight: Poise and presentation athletics, community and/or work activities Criteria #2: Essay (written after arriving for interview) Criteria #4: Commitment Measurement: 15 points Measurement: 40 points Weight: Commitment to a career and studies Weight: Clear and concise with good ideas as demonstrated in the essay portion of the application Criteria #3: Interview Measurement: 40 points Weight: Substance and content of presentation Criteria #5: Character Measurement: 25 points Franklin County Community Foundation Lilly Endowment Community Scholarship PERSONAL DATA

Please type all information. Neatness and clarity are important.

Applicant’s Name ______Last First Middle

Address ______No. Street City State Zip

Township ______Phone ( ) ______Cell Phone ( )______

Date of Birth ______Email Address ______

Are you a resident of Indiana? ______yes ______no

Are you a resident of Franklin County? ______yes ______no

High School Attending ______Year graduating ______

Family Information:

Father or guardian ______

Address (if different from your own) ______

Mother or guardian ______

Address (if different from your own) ______

Name and address of employer of father, mother and or/legal guardian:

Name ______Name ______

Employer ______Employer ______

Employer Address ______Employer Address ______

Length of Employment ______Length of Employment ______PLEASE MAKE SURE THIS IS THE BEGINNING OF A NEW PAGE BEFORE YOU PRINT THE APPLICATION

Father’s occupation ______

Mother’s occupation______

Has a sibling (brother or sister) received the Lilly Endowment Community Scholarship? ______

Are you a first-generation college student? ______

List the ages of other children living in your household ______

List the number of your siblings who are currently enrolled in college______

Colleges applied to: Accepted Pending

______

LEADERSHIP AND CHARACTER

Work Experience

During your high school years did you work during vacations, outside of school hours or during summers? ___ No ___ Yes If yes, during what years of school did you work? (See grid below.)

Dates of Employer Number of Duties Seasonal? employment hours worked per week

Senior ______

Junior ______

Sophomore ______

Freshman ______

The scholarship selection committee will be evaluating the quality, not necessarily the quantity of the following activities. Remember, you may attach additional sheets if necessary.

List in order of importance to you school activities or special projects in which you participated (indicate offices, years involved and responsibilities held):

List in order of importance to you community service activities or community projects you have been involved with. Did you face any adversity or overcome any obstacle to participate in school activities?

Tell about a volunteer experience that had an impact on you.

What would you do if your roommate’s behavior and housekeeping habits were so much different from yours that you no longer felt comfortable in your own room?

What do you plan to do to make your community a better place?

Have you ever been suspended, expelled or dismissed from school, or been on in-school suspension or out-of-school suspension during high school? If yes, please explain.

Explain a situation when you had to make a difficult choice that tested your character.

AWARDS AND HONORS

List any awards or honors (academic, community, athletics, work, etc.) you have received in the past three years and any you are aware of for your upcoming senior year.

Awards Year(s)

______

ESSAY CRITERIA

Type or word process an essay of approximately 300 words describing your personal and educational goals including plans for your career, future and any qualities or traits that may set you apart from other applicants. Do not include your name in the essay. In order to implement an objective selection process, a number will be assigned to your application. Finalists will be required to write a short essay on a topic given to them by the selection committee at the time they are personally interviewed by the committee. AFFIRMATION

______affirms that: Name of Applicant (please print)

1. “If I receive this scholarship, it is my intent to pursue four years of undergraduate study on a full-time basis leading to a baccalaureate degree at an Indiana college.” 2. “I understand that the total maximum amount of my scholarship is calculated on the basis of my chosen college’s tuition and required fees beginning with the 2018-19 school year.” 3. “To assist with the processing of my scholarship payments each semester or quarter and to avoid late fees, I will forward to the Franklin County Community Foundation immediately upon receipt all invoices for tuition and any eligible fees that may be covered by my scholarship.” 4. “I will account for the amount of the special allocation spent for required books and required equipment with official receipts and other documentation. I will return to Independent Colleges of Indiana any amount of the special allocation remaining at the end of each school year.” 5. “I agree to notify Independent Colleges of Indiana of any scholarship awards I may receive for tuition or required fees from a source other than the Lilly Endowment Community Scholarship.” 6. “I will keep the Franklin County Community Foundation apprised annually by June 1st of my enrollment and academic status during college, by completing and returning any surveys or forms as may be provided by the community foundation.” 7. “Upon graduation, I will keep the Franklin County Community Foundation apprised annually by June 1 st of my education and/or employment status for at least ten years after graduation by completing and returning an alumni survey or other forms as may be provided by the community foundation.”

Signed ______Date ______

CERTIFICATION Applicant Name ______

Address ______

Home Phone No. ______Cell Phone No.______

I CERTIFY THAT ALL THE INFORMATION ON THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. If asked by any authorized official of the Franklin County Community Foundation, I realize that failure to comply with a request for further information may prevent the applicant from receiving any aid.

I FURTHER CERTIFY THAT THE APPLICANT IS NOT APPLYING FOR A LILLY ENDOWMENT COMMUNITY SCHOLAR AWARD FROM ANY OTHER COMMUNITY FOUNDATION.

______Applicant Date

______Parent/Legal Guardian Date

All parties involved in this application must sign this certification in order to have the application considered. The Foundation shall reserve the right to withdraw the scholarship if the recipient should conduct himself/herself in such a manner that would result in and reflect an unfavorable image upon the Foundation and the Lilly Endowment Community Scholarship program. The applicant, if chosen as a Lilly Endowment Community Scholar, must sign the FCCF Conditions of Retention annually to receive and continue in the scholarship program. The conditions include:

1. Represent Franklin County and the FCCF in a positive manner. 2. Submit all Book Stipend Reports, receipts, reimbursements, status reports, grade transcripts and essays by the established deadlines as supplied. 3. Meet with the Foundation Board and staff for an individual appointment each year between May and August upon, and at the time specified in, a notice provided to you by the FCCF staff. 4. Engage in no illegal activities, including minor consumption of alcohol, including juvenile misdemeanor and felony offense. 5. Consent to the release by all officers of law enforcement, college administrators and all other entities that may have possession of otherwise confidential materials of all juvenile records and other documents bearing upon your conduct from the date of this document and for so long as you continue to receive this scholarship. APPLICANT APPRAISAL

Student: Make three copies of this appraisal and distribute to three adults. One recommendation may be completed by a school administrator or teacher and the remaining two from a community or religious leader, employer or another person in a position of authority who knows you and your accomplishments. Members of the FCCF Board of Directors and staff are not permitted to write appraisals. Remember to collect the appraisals from the adults and include them with your application or have the adults mail their appraisals to the FCCF Office, 527 Main Street, Brookville, IN 47012 by September 5, 2017. FCCF will take care of photocopying the applicant appraisals.

______Student’s Name

Please give us your candid estimate of the following: the nature of the applicant’s intellectual qualities and academic abilities, emphasizing both strengths and weaknesses; the applicant’s character and personal strengths and weaknesses; any special talents or interests the applicant may have; and any additional observations that you believe would be relevant. We are especially interested in any special circumstances or background information that might give us added insight as we consider this application. You need not list activities, as the student will have provided us with such a listing in the application. Please limit your response to one page, typed. Attach this sheet to the front of your response. Do not include the student’s name in your response, as the FCCF will attempt to preserve the anonymity of the student during the initial review. However, please use the appropriate pronoun (he/she) when referring to the student. You must sign your recommendation letter and print your name below your signature along with your relationship to the applicant. Without a signature the letter will not be considered.

Appraiser’s Name (please print) ______

Appraiser’s Signature ______Title ______

Date ______Telephone ______

Appraiser: Please insert your appraisal into a sealed envelope with your signature across the seal. Students may include your appraisal with their application or you can mail to the FCCF office. Remember, the completed application is due to the Foundation by 4pm on September 5, 2017. References submitted after the deadline date will not be considered by the committee.

Executive Director Franklin County Community Foundation, Inc. 527 Main Street, Brookville, IN 47012 To be completed by Applicant’s High School Guidance Department

REQUEST FOR TRANSCRIPT AND RECOMMENDATION

Counselors: Please include a copy of this student’s transcript, which must include their senior schedule. Transcripts must be signed by the counselor. You may return this form along with the student’s transcript to the student or deliver them to the FCCF office by 4pm on September 5, 2017. If mailing, please deliver to;

Executive Director Franklin County Community Foundation, Inc. 527 Main Street Brookville, IN 47012

Following information to be completed by the High School Counselor;

Student’s name ______Last First MI

Name of high school ______

School address ______

High School CEEB Code ______Date of Graduation ______

Counselor’s name ______Phone______

IF NOT INCLUDED IN THE TRANSCRIPT, PLEASE PROVIDE THE FOLLOWING INFORMATION

Academic Performance: Rank in class (9/150 format) ______GPA ______

SAT: Verbal ______Math ______Writing ______

ACT: English ______Math ______Reading ______

Science Reasoning ______Composite ______

Special academic program which student followed during high school:

21st Century Scholar Yes _____ No _____

National Merit Finalist Yes _____ No _____

Academic Honors Yes _____ No _____

Core 40 Yes _____ No _____

Information must be returned to the student or delivered to the FCCF office on or before September 5, 2017.