Adams County Community Foundation (ACCF)

2015 Application Adams County Community Foundation (ACCF) Scholarship Application – Nomination Form For scholarship funds within the Adams County Community Foundation, for a Eric Richard Mies Memorial Scholarship 102 N. 2nd St. / Decatur, In 46733 / email: [email protected]

Eligibility: Adams Central High School student current or an alumni Trip /travel to: ______ is interested in exploring travel and adventure programs Dates of this trip: Required attachments: ______to ______ Most recent transcripts  A letter of recommendation from a non-family member. This application may be completed by the student or someone who is nominating this student.

Name (of person being nominated): ______Student’s first student’s last

date of graduation from high school: ______month / year

Address: ______city: ______IN zip ______

Phone: (landline) ______(cell) ______

Email address: ______(please print legibly) Relationship to student being nominated: Author of this nomination form: first last ______Name: ______Address: ______city ______st. _____ zip ______

phone: day: ______cell: ______# of years you have email address: ______(please print legibly) known this student: ___

College information: name of college / location

College this student plans to attend: ______/ ______this fall

Field of study this student plans to pursue: ______

Please complete these sentences: 1. I think ______is a good candidate for an ACCF/Eric Richard Mies Scholarship because he/she has ______You may attach another page if necessary. 2. He/she has been interested in travel and adventure and has shown above average interest through his/her experiences. Some examples of these are: ______You may attach another page if necessary.

1 / 2 pages 3. Please list the student’s five and ten year goals and how this scholarship is related to this student’s goals.

______You may attach another page if necessary.

4. Is there anything you would like to the committee to know about this student &/or his/her family?

______You may attach another page if necessary.

Place of student’s employment: ______title: ______

Students works: Full time: ______Part time: ______(Approx number of hours)

For check processing: The ACCF will process the scholarship award check to the student’s trip planning organization (typically the school or a church). Please provide this information:

Name of organization: ______/ address: ______

Contact person for this trip / organization: ______contact ph #: ______

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 community, Adams County Community Foundation, and any other scholarship associated with the Foundation.

I certify that the information provided on this application is complete and accurate to the best of my knowledge. Falsification of information may result in termination of grant to the student.

The student’s signature gives the Adams County Community Foundation permission to contact his/her guidance department to verify information on this application is true.

Student’s signature for which this nomination is submitted: (if under 18, signature of parent or guardian is required):

______Printed name signature date

Guidance Counselor (Adams Central School) signature or AC Transcript (attached):

______Printed name phone number

Attach to this application: 1. Student’s transcripts 2. Student’s letter of recommendation (non-family) 3. Student’s essay

Due date: Fri., May 1, 2015 by 4:00 pm in the ACCF office (no exceptions). Only a single copy of this application is necessary to submit.

Thank you for taking the time to submit this application to the Adams County Community Foundation (ACCF)/ 102 N. 2nd St. / Decatur, In 46733. Hours: M-F, 8-4 pm / ph: 260.724-3939 Applications dropped off before or after hours may use the ACCF mail slot on the Madison Street door. This application may also be electronically submitted to the ACCF: [email protected] If postal mailing or sending electronically, please contact the ACCF to confirm receipt of application.

This ends the application for the Eric Richard Mies Scholarship. / Essay requirements – follow.

2 / 2 2014-2015 Adams Central students Eric Richard Mies Memorial / Travel and Adventure Scholarship essay required Eligibility and Student requirements: Details of the Eric Richard Mies Memorial Scholarship Fund are: Student must:  Be an Adams Central student or alumni  Be a high school student with the intentions to participate in exchange, study abroad, educational, or international travel  Complete the application process prior to the ACCF due date (date may vary depending upon travel programs associated). The Eric Richard Mies Memorial Scholarship committee is:  Jennifer (Mies) K. Temple will review all applications, essays/ letters of recommendation of potential candidates to verify eligibility  The family (as Jennifer Mies-Temple, primary contact) will review applications to determine scholars.  The Adams County Community Foundation (ACCF) Scholarship Committee is the final decision maker of this scholar to insure all IRS and ACCF guidelines have been followed. It is understood that no family member of the scholarship committee may be a recipient of this scholarship, to consist of: child, grandchild, great-child, to include steps Number / Amount awarded in 2014: one at $500 & two at $100* / 2013: one at $500 & two at $100* In 2015: Number / Amount awarded: multiple awards, up to $500 and/or up to $100. *for passport costs Scholarship will be awarded based on: Eric Richard Mies essay and application information Essay Requirements: Student must submit 1 copy (total) of the essay to the ACCF.  Length / Font: maximum two pages, double spaced, margins: 1” / 12 (maximum), 10 minimum)  Author: Student’s name, high school /college, and anticipated travel destination  Essay title: Eric Richard Mies Memorial Scholarship (centered)  Due: by 4:00 pm, TBA (late essays will be returned)

Note to applicant: When evaluating the Eric Richard Mies essays, the selection committee will look for the description of behavior or the lifestyle of the applicant. This essay must be computer generated. Eric thoroughly enjoyed his travel experiences. This scholarship is intended to memorialize Eric and to promote the excitement and adventure of travel. Travel can fully influence a person. Eric and his family wish to encourage this experience. Please address how you view the importance of travel: Applicants may choose to complete one of the three of the following topics: Essay questions: 1. One of Eric’s most memorable characteristics was his ability to connect, befriend and maintain contact with people of all cultural and socioeconomic backgrounds. How do you believe that diverse travels and adventures can influence YOUR personality to connect more openly with others? 2. Although Eric’s life was cut short to fulfill, one of his “bucket list” items was to mentor high-school age students interested in international entrepreneurship. His idea conceptualized an organization that would sponsor local entrepreneurship clubs, based on the principles of “think-tank” or “business incubation” centers. Assuming you were to organize and promote a pilot chapter at your school or in your community, how would you encourage cultural diversity and participation? 3. Of the many stories you will hear of Eric’s life and how he touched others, which one stands out to you as inspiration to lead a life of travel and adventure? (The Mies family will provide a packet with info about Eric, including stories). This component is not completed yet. Upon receipt of this award / integrity obligation, the student agrees to the following (some components are still being created). To be considered for future Eric Richard Mies awards, the student will participate in: 1. “Pay it forward” – Help existing selection committee expand the exposure of the scholarship by qualifying and recommending at least two (2) candidates for future scholarships. 2. Memorialize their travels – Maintain a travel/inspirational blog within the Eric R. Mies Memorial Scholarship Fund website. (website to be created) 3. Advance the cause – Volunteer fundraising time (commensurate with value of scholarship received, at minimum) to enable the future success of the fund.

Thank you for your interest. Please contact the ACCF if you have questions.