Ann`s Choice Named and Special Scholarships 2015
Ann’s Choice Named and Special Scholarships 2015 The Fine Arts Scholarship The H & R Scholarship Helen E. Slemmer Memorial Scholarship Daniel and Bertha Memorial Scholarship Mary Van Wieren Memorial Scholarship Ann’s Choice Lifelong Learning Academy Scholarship Bess Vukas Jordan Memorial Scholarship The Tolerance Scholarship Important Notes: All Special Scholarship recipients must be able to attend the Scholarship Ceremony & Reception that will be held on Wednesday, June 3, 2015 at 7:00 PM at the Ann’s Choice Chapel. All applicants must be attending school during the fall 2015 term. The Selection Committee will interview candidates during the month of May for all Named and Special Scholarships. If you are applying for more than one scholarship you may submit the same essay for each scholarship (just need to turn in one copy). The applications and essays are due to the Philanthropy Department by Friday, March 27, 2015. Information and requirements about each scholarship are provided in this booklet. If you have questions about the Named and/or Ann’s Choice Special Scholarships please contact: Susan Abtouche 215.443.3159 [email protected] Fine Arts Special Scholarship An anonymous resident donor has created a special scholarship for students studying fine arts at a college or university. The applicant must be a graduating senior. The applicant must be studying fine arts at a college or university. This is a one-time $500 scholarship. (If the recipient demonstrates that he/she is doing well in the fine arts program and continues studying fine arts, the donor may continue to provide the scholarship but this is not guaranteed). The applicant can use the same essay written for the Ann’s Choice Scholarship but should include information regarding the reason for pursuing a fine arts degree in that essay. The applicant must be interviewed by the scholarship selection committee during May 2015. The application is due to the Philanthropy Department by March 27, 2015. The applicant must be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. The H & R Special Scholarship An anonymous resident donor couple has created a special, one-time $4,000 scholarship for graduating seniors. The applicant must be a graduating senior. The applicant must demonstrate financial need. This is a one-time $4,000.00 scholarship. The applicant must demonstrate a strong work ethic. The applicant can use the same essay that is being submitted for the regular Ann’s Choice Scholarship The applicant must be interviewed by the Scholarship selection committee during the month of May 2015. The applicant must be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. The Helen E. Slemmer Memorial Scholarship The Helen E. Slemmer Memorial Scholarship will pay $5,000 per year for up to four years and will be presented to one staff member per year. The current balance of the fund is $109,538.00. Charles Slemmer (pictured above) loved living at Ann’s Choice and said that the staff members were like family to him. He wanted to make a difference in peoples’ lives by creating a scholarship. And he could not think of a better way to honor his mother’s memory and have it live on. As Charles said several years ago, “Nothing would make my mother happier. I think she is up there looking down and smiling right now.” Charles passed away in 2010. Charles and his beloved mother are now together looking down and smiling. Applicants must: Be registered as a full time student at an institution of higher learning. Write an essay regarding what the scholarship and the education obtained means to him or her and what it will help him/her achieve. Graduating seniors applying for the Ann’s Choice Scholarship can use the same essay for this scholarship. Be interviewed by the Ann’s Choice Scholarship Selection Committee during May 2015. Be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. Have a financial need. Submit 2014 family income verification form and tax returns. (Social Security numbers must be blacked out). Family adjusted gross income must be less than $75,000. Daniel and Bertha Memorial Scholarship One-time $4,000 scholarship - can be divided between multiple recipients. “My grandparents, Daniel and Bertha (left), showed great foresight by providing rather nicely for their grandchildren. Since we tithe what we are given, we needed to find a use for some of the money. My grandparents were not religious. However, they educated all of their seven children and all of my siblings and I were educated. Therefore, helping others get education would be an appropriate way to use the dedicated money.” ~Anonymous Resident Donor Applicants must: Be an employee (student or any other employee) in good standing. Be planning on attending a community college or trade school. Have passed his/her 90-day probation period. Have exhausted Ann’s Choice assistance (including tuition reimbursement). Student must be paying at least 50% of tuition. Complete the application. Submit documentation showing financial need and the 2014 family income verification form. Tax returns should have social security numbers blacked out. Write an essay regarding what the scholarship and the education obtained means to him or her and what it will help the applicant achieve, including his or her goals (must by typed). Graduating seniors applying for the Ann’s Choice Scholarship can use the same essay for this scholarship. Be interviewed by the Ann’s Choice Scholarship Selection Committee during May 2015. Be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. Mary Van Wieren Memorial Scholarship The Mary Van Wieren Memorial Scholarship is for students only (graduating seniors are eligible) and is a one-time $1,500 scholarship. Mary loved the student workers and education - that is why her family is creating this scholarship to honor her memory. Applicants must: Be furthering his or her education by attending or taking courses at a 4-year college, a community college or a trade school. Special preference will be given to Nursing students since Mary was a nurse. Have a minimum GPA of 3.0 Write an essay regarding what the scholarship means to him or her and what it will help the applicant achieve, including his or her goals. The essay should also include any volunteer or community service work that the applicant has done. This essay must be typed. Applicant should have a personality like Mary (cares about others). Must be interviewed by the Ann’s Choice Scholarship Committee during May 2015. Be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. Mary Elizabeth Van Wieren, was a retired nurse. The majority of her career was spent at Abington Memorial Hospital working in the operating room as an orthopedic O.R. nurse. While at Abington, Martha earned the respect and love of many of the hospital's doctors and nurses because of her funloving, caring, and professional ways. In 2005, Mary moved to Ann's Choice in Warminster, where she actively exercised at the fitness center and pool, volunteered in the library, delivered meals to other residents, helped as a cubby stuffer, enjoyed many trips to the theatre, as well as drove her friends to the grocery store. Mary's easy going and fun-loving spirit garnered her many friends with whom she loved sitting and talking with while enjoying dinner. Ann’s Choice Lifelong Learning Academy Scholarship The Ann’s Choice Lifelong Learning Academy (ACLLA) is happy to announce that they are offering one $3,000.00 scholarship for the 20152016 school year. This scholarship will be available to any staff member or student staff member who meets the following criteria: Applicant must be furthering his or her education by attending or taking courses at a 4-year college, a community college or a trade school. Applicant must write an essay regarding what the scholarship and education obtained means to him or her and what it will help the applicant achieve, including his or her goals. This essay must be typed. Graduating seniors applying for the Ann’s Choice Scholarship can use the same essay for this scholarship. Applicant must be interviewed by the Ann’s Choice Scholarship Committee during May 2015. Application and essay due to the Philanthropy Department by Friday, March 27, 2015. The scholarship recipient must be able to attend the Ann’s Choice Scholarship Ceremony on June 3, 2015. ACLLA Panel Bess Vukas Jordan Memorial Scholarship The Bess Vukas Jordan Memorial Scholarship is for a 2015 graduating senior (from high school) and is a one-time $1,500 scholarship. Applicants must: Be furthering his or her education by attending or taking courses at a 4-year college, a community college or a trade school. Special preference will be given to nursing students since Bess was a nurse. Write an essay regarding what the scholarship means to him or her and what it will help the applicant achieve, including his or her goals. The essay should also include any volunteer or community service work that the applicant has done. Applicant should have a genuine desire for a medical career. Must be interviewed by the Ann’s Choice Scholarship Committee during May 2015. Applicant must complete the application. The scholarship recipient must be able to attend the Ann’s Choice Scholarship Ceremony on June 3, 2015. Bess was an army nurse serving both at home and in Japan and Korea during World War II and the Korean conflict. After retirement she worked in hospitals in the Smithtown, New York area. A proud, dedicated professional who read her bible daily, she earned the respect of many professionals with whom she worked. Bess encouraged nursing as a career. She was a major donor to and member of the President’s Society, at the Western Pennsylvania Hospital School of Nursing in Pittsburgh. Her husband David resides at Ann’s Choice. The Tolerance Scholarship given by Gerald and Miriam Shur This is a one-time, $1,000 scholarship for a student graduating from high school. This scholarship is presented to the applicant who best demonstrates a strong understanding of the need for tolerance and respect among all peoples, regardless of their race, religion, sexual orientation, or political views. The requirements for this scholarship: The applicant must be a graduating senior. The applicant must be an employee in good standing. The applicant must write an essay using one or more of the considerations below or any other that the applicant feels appropriate: Discuss a situation in which you encountered or observed intolerance (either toward yourself, or toward someone else) and what you did if anything, in response. In what areas of our society do you see a greater need for tolerance? What could you do in order to ensure that tolerance is achieved? Explain a situation in which you acknowledge that you were wrongly intolerant of others, and why you believe that you acted the way that you did. What do you think tolerance means to your generation? Do you think your generation is more or less tolerant than the generations before it? Why do you think this? Members of the Ann’s Choice Scholarship Selection Committee will read the essays. The Selection Committee will interview the top three applicants (during May of 2015) and choose one recipient to receive the one-time, $1,000.00 scholarship. The recipient must attend the Scholarship Ceremony on June 3, 2015. The applicant must complete the scholarship application. Scholarship Checklist Name:______________________________________ I am applying for the following scholarships: The Ann’s Choice Fine Arts Scholarship The H & R Special Scholarship Helen E. Slemmer Memorial Scholarship (include 2014 tax returns with social security numbers blacked out and complete Family Income Form). Must have a household adjusted gross income under $75,000 to be considered. The Daniel and Bertha Memorial Scholarship (include 2014 tax returns with social security numbers blacked out and complete Family Income Form). Must have a household adjusted gross income under $75,000 to be considered. Mary Van Wieren Memorial Scholarship (must have minimum GPA of 3.0 and provide documentation such as a high school transcript or current copy of a report card with GPA listed.) Ann’s Choice Lifelong Learning Academy Scholarship Bess Vukas Jordan Memorial Scholarship The Tolerance Scholarship given by Gerald and Miriam Shur The Ann’s Choice Fine Arts Scholarship 2015 Name:__________________________________ Address: ________________________________ E-mail address: __________________________ Phone Number: __________________________ Department at Ann’s Choice: _______________ Manager/Supervisor: ______________________ Please complete this form and attach (paper clip) the required documents listed below and turn in to the Philanthropy Department by 5:00 PM on Friday, March 27, 2015. The Philanthropy Department office is located on the second floor of Liberty Commons or the application can be mailed to: Ann’s Choice Philanthropy Office, 20000 Ann’s Choice Way, Warminster, PA 18974 (must be received by March 27, 2015 to be considered). Phone number is (215) 443-3159. Requirements—Please see all requirements in program booklet. Must be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. Must be furthering his or her education by attending or taking courses at a 4-year college, a community college or a trade school. Write an essay regarding what the scholarship means to him or her and what it will help him or her achieve, including what his or her goals are. This essay must be typed. Must be interview by the Ann’s Choice Scholarship Selection Committee. Complete the above information regarding contact information. Sign this application. Once the application packet is reviewed by the Philanthropy Department and it is determined that you meet the requirements to be eligible, each eligible applicant will be contacted and move forward to be interviewed by the Ann’s Choice Scholarship Selection Committee during May 2015. By signing and dating this document, I understand the requirements that must be fulfilled in order to be considered to receive this scholarship. I understand that the recipient or recipients will be determined by the Ann’s Choice Scholarship Selection Committee and their decision is final. This scholarship is not a preset amount, after interviewing all of the applicants, the selection committee will determine which applicant or applicants will receive assistance. The assistance given will be based on need of the applicant and partially based on amount of tuition the applicant is paying. Signature: ________________________________ Date: ______________________ The H & R Special Scholarship 2015 Application Name:__________________________________ Address: ________________________________ E-mail address: __________________________ Phone Number: __________________________ Department at Ann’s Choice: _______________ Manager/Supervisor: ______________________ Please complete this form and attach (paper clip) the required documents listed below and turn in to the Philanthropy Department by 5:00 PM on Friday, March 27, 2015. The Philanthropy Department office is located on the second floor of Liberty Commons or the application can be mailed to: Ann’s Choice Philanthropy Office, 20000 Ann’s Choice Way, Warminster, PA 18974 (must be received by March 27, 2015 to be considered). Phone number is (215) 443-3159. Requirements Must be furthering his or her education by attending or taking courses at a 4-year college, a community college or a trade school. Write an essay regarding what the scholarship means to him or her and what it will help him or her achieve, including what his or her goals are. This essay must be typed. Must be interview by the Ann’s Choice Scholarship Selection Committee. Complete the above information regarding contact information. Sign this application. Must be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. Once the application packet is reviewed by the Philanthropy Department and it is determined that the applicant has met the requirements to be eligible, each eligible applicant will move forward to be interviewed by the Ann’s Choice Scholarship Selection Committee during May of 2015. By signing and dating this document, I understand the requirements that must be fulfilled in order to be considered to receive this scholarship. I understand that only one staff member will receive the H & R Special Scholarship and the recipient will be determined by the Ann’s Choice Scholarship Selection Committee and their decision is final. In addition to the requirements mentioned above, I also understand that if I am the recipient of the scholarship, I will agree that my name and photo may be used in print materials and on our TV station and I will attend the Ann’s Choice Scholarship Ceremony on the evening of June 3, 2015. If I am the recipient of this scholarship, I agree to write a thank you note to the donor. Signature: ________________________________ Date: ______________________ The Helen Elizabeth Slemmer Memorial Scholarship 2015 Application Name:__________________________________ Address: ________________________________ E-mail address: __________________________ Phone Number: __________________________ Department at Ann’s Choice: _______________ Manager/Supervisor: ______________________ Please complete this form and attach (paper clip) the required documents listed below and turn in to the Philanthropy Department by 5:00 PM on March 27, 2015. The Philanthropy Department office is located on the second floor of Liberty Commons or the application can be mailed to: Ann’s Choice Philanthropy Office, 20000 Ann’s Choice Way, Warminster, PA 18974 (must be received by March 27, 2015 to be considered). Phone number is (215) 443-3159. Requirements Proof of family income (household adjusted gross income under $75,000) for 2014. Please submit copy of 2014 tax return and complete attached sheet. Provide documentation of other scholarships and awards granted. Write an essay regarding what the scholarship will mean to you and what it will help you to achieve. Graduating seniors providing an essay for the regular Ann’s Choice Scholarship can use that essay. Provide documentation of full-time enrollment (for the fall 2015 semester) at an institution of higher learning. (If you are deciding between schools, please provide that information). Complete the above information regarding contact information. Sign this application. Must be interview by the Ann’s Choice Scholarship Selection Committee. Must be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. Once the application packet is reviewed by the Philanthropy Department and the Director of Human Resources, and it is determined that the applicant has met the requirements to be eligible, each eligible applicant will move forward to be interviewed by the Ann’s Choice Scholarship Selection Committee during May of 2015. By signing and dating this document, I understand the requirements that must be fulfilled in order to be considered to receive this scholarship. I understand that only one staff member will receive the Helen Elizabeth Slemmer Memorial Scholarship in 2015 and the recipient will be determined by the Ann’s Choice Scholarship Selection Committee and their decision is final. In addition to the requirements mentioned above, I also understand that if I am the recipient of the scholarship, I will agree that my name and photo may be used in print materials and on our TV station and I will attend the Ann’s Choice Scholarship Ceremony on the evening of June 3, 2015. If I am the recipient of this scholarship, I agree to write a thank you note to the donor’s nephew for each year that I receive the award and to keep him apprised of my progress at school. Signature: ________________________________ Date: _______________________________ The Daniel and Bertha Memorial Scholarship Award 2015 Application Name:__________________________________ Address: ________________________________ E-mail address: __________________________ Phone Number: __________________________ Department at Ann’s Choice: _______________ Manager/Supervisor: ______________________ Please complete this form and attach (paper clip) the required documents listed below and turn in to the Philanthropy Department by 5:00 PM on Friday, March 27, 2015. The Philanthropy Department office is located on the second floor of Liberty Commons or the application can be mailed to: Ann’s Choice Philanthropy Office, 20000 Ann’s Choice Way, Warminster, PA 18974 (must be received by March 27, 2015 to be considered). Phone number is (215) 443-3159. Requirements—Please see all requirements in this program booklet. Proof of family income (household adjusted gross income under $75,000) for 2014. Please submit copy of 2014 tax return and complete attached sheet. Provide documentation of other scholarships and awards granted. Write an essay regarding what the scholarship will mean to you and what it will help you to achieve. Graduating seniors providing an essay for the regular Ann’s Choice Scholarship can use that essay. Provide documentation of full-time enrollment (for the fall 2015 semester) at an institution of higher learning. (If you are deciding between schools, please provide that information). Complete the above information regarding contact information. Sign this application. Must be interview by the Ann’s Choice Scholarship Selection Committee. Must be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. Once the application packet is reviewed by the Philanthropy Department and it is determined that the applicant has met the requirements to be eligible, each eligible applicant will be contacted and move forward to be interviewed by the Ann’s Choice Scholarship Selection Committee (residents and Director of Philanthropy) during May 2015. By signing and dating this document, I understand the requirements that must be fulfilled in order to be considered to receive this scholarship. I understand that the recipient or recipients will be determined by the Ann’s Choice Scholarship Selection Committee and their decision is final. This scholarship is not a preset amount, after interviewing all of the applicants, the selection committee will determine which applicant or applicants will receive assistance. The assistance given will be based on need of the applicant and partially based on amount of tuition the applicant is paying. Signature: ________________________________ Date: ______________________ 2015 Mary Van Wieren Memorial Scholarship Name:_______________________________________ Phone Number: __________________________ Address: _____________________________________ E-mail address: __________________________ Department at Ann’s Choice: ____________________ Manager/Supervisor: ______________________ Please complete this form and attach (paper clip) the required documents listed below and turn in to the Philanthropy Department by 5:00 PM on Friday, March 27, 2015. The Philanthropy Department office is located on the second floor of Liberty Commons or the application can be mailed to: Ann’s Choice Philanthropy Office, 20000 Ann’s Choice Way, Warminster, PA 18974 (must be received by March 27, 2015 to be considered). Phone number is (215) 443-3159. Write an essay regarding what the scholarship and education obtained means to you and what it will help you to achieve. If you are a graduating senior applying for the Ann’s Choice Scholarship you only need to turn in one essay. Provide documentation of full-time enrollment (for the fall 2015 semester) at an institution of higher learning. (If you are deciding between schools, please provide that information). Complete the above information regarding contact information. Sign this application . Must be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. Must be interview by the Ann’s Choice Scholarship Selection Committee. Once your application packet is reviewed by the Philanthropy Department and the Director of Human Resources, and it is determined that the applicant has met the requirements to be eligible, each eligible applicant will move forward to be interviewed by the Ann’s Choice Scholarship Selection Committee during May of 2015. By signing and dating this document, I understand the requirements that must be fulfilled in order to be considered to receive this scholarship. I understand that only one staff member will receive the Mary Van Wieren Memorial Scholarship in 2015 and the recipient will be determined by the Ann’s Choice Scholarship Selection Committee and their decision is final. In addition to the requirements mentioned above, I also understand that if I am the recipient of this scholarship, I will agree that my name and photo may be used in print materials and on our TV station and I will attend the Ann’s Choice Scholarship Ceremony on the evening of June 3, 2015. If I am the recipient of the scholarship, I agree to write a thank you note to the donor and to keep the donor apprised of my progress at school. Signature: ________________________________ Date: _______________________________ Ann’s Choice Lifelong Learning Academy Scholarship 2015 Application Name:__________________________________ Address: ________________________________ E-mail address: __________________________ Phone Number: __________________________ Department at Ann’s Choice: _______________ Manager/Supervisor: ______________________ Please complete this form and attach (paper clip) the required documents listed below and turn in to the Philanthropy Department by 5:00 PM on March 27, 2015. The Philanthropy Department office is located on the second floor of Liberty Commons or the application can be mailed to: Ann’s Choice Philanthropy Office, 20000 Ann’s Choice Way, Warminster, PA 18974 (must be received by March 27, 2015 to be considered). Phone number is (215) 443-3159. Requirements Must be furthering his or her education by attending or taking courses at a 4-year college, a community college or a trade school. Write an essay regarding what the scholarship means to him or her and what it will help him or her achieve, including what his or her goals are. This essay must be typed. Must be interviewed by the Ann’s Choice Scholarship Selection Committee. Complete the above information regarding contact information. Sign this application. Must be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. Once your application packet is reviewed by the Philanthropy Department and it is determined that the applicant has met the requirements to be eligible, each eligible applicant will move forward to be interviewed by the Ann’s Choice Scholarship Selection Committee during May of 2015. By signing and dating this document, I understand the requirements that must be fulfilled in order to be considered to receive this scholarship. I understand that only one staff members will receive the Ann’s Choice Lifelong Learning Academy Scholarship in 2015 and the recipient will be determined by the Ann’s Choice Scholarship Selection Committee and their decision is final. In addition to the requirements mentioned above, I also understand that if I am the recipient of the scholarship, I will agree that my name and photo may be used in print materials and on our TV station and I will attend the Ann’s Choice Scholarship Ceremony on the evening of June 3, 2015. If I am the recipient of this scholarship, I agree to write a thank you note to the donor for each year that I receive the award and to keep them apprised of my progress at school. Signature: ________________________________ Date: ______________________ Bess Vukas Jordan Memorial Scholarship 2015 Application Name:__________________________________ Address: ________________________________ E-mail address: __________________________ Phone Number: __________________________ Department at Ann’s Choice: _______________ Manager/Supervisor: ______________________ Please complete this form and attach (paper clip) the required documents listed below and turn in to the Philanthropy Department by 5:00 PM on March 27, 2015. The Philanthropy Department office is located on the second floor of Liberty Commons or the application can be mailed to: Ann’s Choice Philanthropy Office, 20000 Ann’s Choice Way, Warminster, PA 18974 (must be received by March 27, 2015 to be considered). Phone number is (215) 443-3159. Requirements Must be furthering his or her education by attending or taking courses at a 4-year college, a community college or a trade school. Write an essay regarding what the scholarship means to him or her and what it will help him or her achieve, including what his or her goals are. The essay should also include any volunteer or community service work that the applicant has done. Must be interviewed by the Ann’s Choice Scholarship Selection Committee. Complete the above information regarding contact information. Sign this application. Once your application packet is reviewed by the Philanthropy Department and it is determined that the applicant has met the requirements to be eligible, each eligible applicant will move forward to be interviewed by the Ann’s Choice Scholarship Selection Committee during May 2015. By signing and dating this document, I understand the requirements that must be fulfilled in order to be considered to receive this scholarship. I understand that only one staff members will receive the Bess Vukas Jordan Memorial Scholarship in 2015 and the recipient will be determined by the Ann’s Choice Scholarship Selection Committee and their decision is final. In addition to the requirements mentioned above, I also understand that if I am the recipient of the scholarship, I will agree that my name and photo may be used in print materials and on our TV station and I will attend the Ann’s Choice Scholarship Ceremony on the evening of June 3, 2015. If I am the recipient of this scholarship, I agree to write a thank you note to the donor for each year that I receive the award and to keep them apprised of my progress at school. Signature: ________________________________ Date: ______________________ The Tolerance Scholarship 2015 Application Name:_______________________________________ Phone Number: __________________________ Address: _____________________________________ E-mail address: __________________________ Department at Ann’s Choice: ____________________ Manager/Supervisor: ______________________ Please complete this form and attach (paper clip) the required documents listed below and turn in to the Philanthropy Department by 5:00 PM on Friday, March 27, 2015. The Philanthropy Department office is located on the second floor of Liberty Commons or the application can be mailed to: Ann’s Choice Philanthropy Office, 20000 Ann’s Choice Way, Warminster, PA 18974 (must be received by March 27, 2015 to be considered). Phone number is (215) 443-3159. Write an essay regarding using one or more of the considerations below or any other one that the applicant feels appropriate: Discuss a situation in which you encountered or observed intolerance (either toward yourself, or toward someone else) and what you did if anything, in response. In what areas of our society do you see a greater need for tolerance? What could you do in order to ensure that tolerance is achieved? Explain a situation in which you acknowledge that you were wrongly intolerant of others, and why you believe that you acted the way that you did. What do you think tolerance means to your generation? Do you think your generation is more or less tolerant than the generations before it? Why do you think this? Provide documentation of full-time enrollment (for the fall 2015 semester) at an institution of higher learning. (If you are deciding between schools, please provide that information). Complete the above information regarding contact information. Sign this application and include check list of which scholarships you are applying for. Must be able to attend the Scholarship Ceremony and Reception on the evening of June 3, 2015. Must be interviewed by the Ann’s Choice Scholarship Selection Committee. Once your application packet is reviewed by the Philanthropy Department and the Director of Human Resources, and it is determined that the applicant has met the requirements to be eligible, each eligible applicant will move forward to be interviewed by the Ann’s Choice Scholarship Selection Committee during May of 2015. By signing and dating this document, I understand the requirements that must be fulfilled in order to be considered to receive this scholarship. I understand that only one staff member will receive the Tolerance Scholarship in 2015 and the recipient will be determined by the Ann’s Choice Scholarship Selection Committee and their decision is final. In addition to the requirements mentioned above, I also understand that if I am the recipient of this scholarship, I will agree that my name and photo may be used in print materials and on our TV station and I will attend the Ann’s Choice Scholarship Ceremony on the evening of June 3, 2015. Signature: ________________________________ Date: _______________________________ Please use for the Helen Elizabeth Slemmer Memorial Scholarship and the Daniel & Bertha Memorial Scholarship 2015 Proof Of Family Income NAME _____________________________________ The household adjusted income must not exceed $75,000. Household income also includes the the employee’s adjusted gross income. Father’s Adjusted Gross Income ____________________ Mother’s adjusted Gross Income ____________________ Parents’ Adjusted Gross Income ____________________ (If filing jointly) Employee’s Adjusted Gross Income ____________________ Other Scholarship Awards ____________________ Total ____________________ Please attach a copy of the previous year’s tax return. I acknowledge that the above information is true and complete. Signature___________________________ DATE______________
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