2023 LILLY ENDOWMENT - Community Foundation of Crawford County

Community Foundation of Crawford County

2023 LILLY ENDOWMENT

COMMUNITY SCHOLARSHIP APPLICATION

The Community Foundation of Crawford County (CFCC) is a non-profit organization that builds permanent resources to meet current and future community needs. One aspect of the mission is to provide scholarships for area students.

DIRECTIONS: All students who will graduate in the top 20% of their class from Crawford County High School are eligible for the scholarship. Part one (1) is for documentation only and is not distributed to the selection committee; therefore, you are asked to list only the last four digits of your Social Security number on the General Information pages. Failure to complete all sections of this application and include all attachments will affect the outcome of the scholarship evaluation.

Completed applications and all required attachments must be submitted electronically here, or received at the Crawford County High School Office by September 2, 2022.

NOTE: Late or incomplete applications will not be considered.

The scholarship application will need to be completed in its entirety at one time.
You will not be able to save and return to finish the application.
We suggest printing a copy to fill out as a guide and having all material ready
to upload when submitting online.

last four digits ONLY of social security number

First Name | MIDDLE INITIAL*

Last Name*

ADDRESS

City

state

zip

date of birth

Phone*

Alternate Phone

Email Address*

PARENT/GUARDIAN 1 NAME

PARENT/GUARDIAN 1 LAST NAME

relation

Address (if different)

city

state

zip code

Parent/Guardian 1 email

PARENT/GUARDIAN 1 phone

Parent/Guardian 2

last name

relation

address (if different)

city

state

zip code

Parent/Guardian 2 email

Parent/Guardian 2 Phone

I am an immediate family member of a current or former CFCC Board Member.

Yes

I Certify that i am a u.s. citizen and that all information given in this application is true. I understand the cFCC may require further verification of this information from me. i understand that falsification of any information will result in the termination of any scholarship(s) granted. I agree and understand that by Typing my name below, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.

I do hereby affirm that I have verified transcripts, class ranks, test scores, diploma type, GPA, and school attendance for the student listed above.

I Agree And Understand That By Typing The Name Below, That All Electronic Signatures Are The Legal Equivalent Of A Manual/Handwritten Signature And I Consent To Be Legally Bound To This Agreement And That Prior Consent To Do So Has Been Obtained By My Director Of Guidance.

Family overview: parents' current marital status: (select one)

Parent/Guardian 1 occupation

Parent Guardian 1 employer

Parent Guardian 1 length

Parent Guardian 2 occupation

Parent Guardian 2 employer

Parent Guardian 2 length

List the number of family members currently living in your household

Are you ae first generation college student (first person in your immediate family to atten college)?

Yes

LIST THE AGES OF BROTHERS, SISTERS, STEP BROTHERS, STEP SISTERS CURRENTLY LIVING WITH YOU IN YOUR HOME INCLUDING THOSE THAT THE FAMILY IS SUPPORTING IN COLLEGE. (DO NOT INCLUDE NAMES.)

LIST COLLEGE, ASSOCIATE OR TECHNICAL SCHOOL STUDENTS IN YOUR FAMILY NEXT YEAR (NOT INCLUDING YOURSELF). (DO NOT INCLUDE NAMES.)

age(s)

year(s) in school

full or part time

name of school(s)

school and community achievements

REQUIRED: List your extra-curricular activities including: clubs, volunteer activities in your community and/or at your place of worship, sports, and work experience. If additional room is needed, you can upload a file with only the last four digits of your Social Security Number in the top right corner. Title the file and page “School /Community Involvement/Achievements”.

start date

finish date

Club/Activity/Employer/Organization

contact person

Phone with area code

Office/position held

HOnors/notable achievements received

AVERAGE HRS./WK.

start date

finish date

CLUB/ACTIVITY/EMPLOYER/ORGANIZATION

CONTACT PERSON

PHONE WITH AREA CODE

OFFICE/POSITION HELD

HONORS/NOTABLE ACHIEVEMENTS RECEIVED

average hrs./wk.

elementary Schoo attended

NUMBER OF YEARS ATTENDED

Graduated from this elementary school?

Education plans

College/University You Plan To Attend

City

Current annual taxable combined (gross) income range of parents/guardians (check one):

Estimated Family Contribution (EFC) - found on Early FASFA Worksheet

FASFA CHECKLIST

I have filed and attached a copy of my Early FAFSA Worksheet to this application.

I understand that if selected to interview for this scholarship, I may be required to provide copies of official FAFSA Reports.

I Certify That I Am A U.S. Citizen And That All Information Given In This Application Is True. I Understand The CFCC May Require Further Verification Of This Information From Me. I Understand That Falsification Of Any Information Will Result In The Termination Of Any Scholarship(S) Granted. I Agree And Understand That By Typing My Name Below, That All Electronic Signatures Are The Legal Equivalent Of My Manual/Handwritten Signature And I Consent To Be Legally Bound To This Agreement And That Prior Consent To Do So Has Been Obtained By My PARENT OR GUARDIAN.

I certify that all information provided is accurate and true, to the best of my knowledge:

Attachments and Instructions

One typed Recommendation Form from a non-family member. The form must be mailed or emailed separately from application to (4030 E. Goodman Ridge Rd., Marengo IN 47140 or lfraime@cf-cc.org)

Indiana college acceptance letter required by the time of the interview if selected

Typed Personal Insight Essay:
typed essay of no fewer than 500 words introducing yourself, defining your vision and personal goals, explaining your chosen field of study, and including where you envision yourself in 10 years

Indiana college financial aid letter(s) if available by the time of the interview if selected

Copy of official transcript of grades

*Optional* Extenuating Circumstances Explanation explain any circumstances affecting your life (academic performance, attendance, financial, familial) in no more than 250 words

Completed Early FASFA Worksheet (official FAFSA reports may be required by interviewees)

LECSP Code of Conduct & Applicant’s Affirmation

By initialing each item and signing this agreement, I confirm the following representations:

Submit Application

2023 CFCC LILLY ENDOWMENT COMMUNITY SCHOLARSHIP

Full tuition/fees for four years plus $900/year for required books and required equipment.
For a student within the school district of Crawford County who will have graduated in the top 20% of their class from Crawford County High School by the end of June 2023 .
Student intends to pursue a full-time baccalaureate course of study at an accredited public or private nonprofit college or university in Indiana.
Three to five students will be selected to interview with the selection committee before the final decision is made.
Recipient must notify the Community Foundation of Crawford County and Independent Colleges of Indiana of his or her final college selection by April 28, 2023.

Questions: Contact Laken Fraime, Community Foundation of Crawford County

(812) 365-2900, lfraime@cf-cc.org

4030 East Goodman Ridge Road, Box D, Marengo, IN 47140