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-A-
2015
DELAVAN-DARIEN HIGH SCHOOL
LOCAL SCHOLARSHIP PROGRAM APPLICATION
NAME:
LAST
FIRST
DIRECTIONS TO APPLICANTS:
! Read the scholarship packet carefully to determine the award(s) for which you are eligible to apply.
(The Senior Class, Elks, and FFA Alumni Awards do not require a formal application.)
! Mark the awards for which you wish to be considered
American Legion Auxiliary Award Unit 95
Delavan-Darien Foundation Scholarships
American Legion Auxiliary Award Unit 450
Benson Family Scholarship
American Legion Award Post 95
Bohn Family Leadership Scholarship
American Legion Award Post 450
Burdette W. Holt Memorial
Aurora Health Care Award
Charles Wileman Memorial
Borg Foundation Achievement Scholarship
Cinco de Mayo Scholarship
George W. Borg Foundation Inc. Science Scholarship
Claude & Kathryn Davis Family Scholarship
George W. Borg And Effie Borg Scholarship
Community Bank Awards
Darien Fire Department – Dennis Doering Scholarship
Darien Corn Festival Chuck & Su Brown Award
Darien Woman’s Club Award
The David N. Austin Memorial
Delavan Lioness Club
Delavan-Darien Foundation Memorial Awards
Delavan Lions Club Scholarships
Doug Kahl Memorial Scholarship
Delavan Soccer Club Scholarship
Eugene Schmig Memorial Scholarship
Delavan-Darien Education Association Award
Delavan-Darien Friends Of The Visual And
Performing Arts Scholarship
Delavan-Darien Gridiron Club Award
Gene Shreves Awards
Delavan-Darien Masonic Scholarship
Jason M. Sterken Memorial Scholarship
Delavan-Darien Optimist Club Awards
Jim Santy Community Service Scholarship
Delavan-Darien Rotary Club Awards
Kathleen Frederick Reader Memorial Award
Delavan-Darien Youth Wrestling Club Scholarship
McGinnis Education Award
Dora S. Arthur Financial Aid Fund
Merlin Moser Award
Fairfield Grange
Michael J. Dillner Memorial Award
Florence Dunwiddie Memorial Fund
Nanette Nicolay Memorial Scholarship
Jacqueline Yanke Memorial
Patrick Schmitt Memorial Scholarship
The Jeremiah Millard Memorial Scholarship
Richard McClellan Smith Memorial Award
Kay Waelti Mamorial Scholarship Fund
Robert Michael Koval Memorial Award
Kikkoman Foods, Inc. Scholarship
Stephanie Roherty Memorial Scholarship
Lakeland Medical Center Medical Staff Scholarship
Wallace Zimmermann Memorial Award
Lynda Cooper Memorial Scholarship
Walworth State Bank Scholarship
National School Orchestra Association
William Boone Memorial Scholarship
Pentair Scholarship
William L. Fleck Memorial Scholarship
Delavan Youth Football Scholarship
Zachary Butler Scholarship
Robert Labonne Scholarship
Sherry L. Rozell Memorial Award
SPX Flow Technology, Delavan Operations
Scholarship
Vincent James Agius Memorial
Howard Knapp Award
Irvin C. and Harriett B. Llewellyn Award
M.I.
!
!
!
1.
Complete the application form.
Detailed instructions for completing this application can be found on page five of the scholarship packet.
Return the completed, signed application to the Student Services Offices by 3:00 p.m., April 16, 2015.
-BName of applicant
LAST
FIRST
2.
Address
3.
Number of older brothers and sisters
4.
Father’s name
Mother’s name
5.
Father’s occupation
Mother’s occupation
6.
Are you the first person in your family to attend college (this includes your parents and siblings)?
7.
What school will you attend after high school?
8.
Have you received official notice of acceptance?
9.
What course or program will you study?
10.
What financial aid have you already received?
11.
Did you submit a Free Application For Federal Student Aid (FAFSA)?
M.I.
Younger
If not, why?
12.
List total number of credits you expect to earn through eight semesters of high school:
List credits by subject: (Note: Total credits listed below will NOT match total credits indicated above.)
PE and Health are NOT counted under list by subject. Sign Language is considered a Foreign Language.
Business Education
Science
Foreign Language
Technology Education
Agriculture
Music & Art
Mathematics
Social Studies
English
13.
Which high school subjects did you enjoy most?
14.
In which subjects did you experience the greatest success?
-C15.
What activities did you participate in while in high school?
ACTIVITY
(Example: soccer)
(Example: forensics)
HONOR OR ACHIEVEMENT
(Example: letter winner)
(Example: state award)
16.
List other special awards or honors you received in high school not covered by the above?
Include any elected offices held.
17.
What out-of-school activities do you participate in? (Example: church youth group, 4-H, etc.)
18.
List work experience that you have had during high school.
19.
Are you are the child or grandchild of a veteran? Attach verification to this application if a specific
scholarship for which you are applying requires proof. (See Student Services for acceptable verification.)
-D20.
For the SERVE requirement for the community service Diploma endorsement how many hours do
you have documented in the Main Office?
If you have documented hours for community service, describe your involvement in the space below:
-E21. Answer the following question in depth: What is your career plan and what has influenced your thinking in
this matter? (Give careful attention to this question.)
-F22. Explain how you plan to finance your education, since consideration for some awards will be given to a
graduating senior who, without such assistance, might not be able to attain the advantage of a college
education. Please comment, in however detailed a manner you wish, on those factors that you believe
enable you to satisfy this financial need requirement. (You might include in this statement, unless your
parents have objections, an indication of your parents’ combined income, the number of brothers and sisters
you have, any unusual circumstances that would further demonstrate your need, and whether you personally
have anything saved to contribute toward your education.)
-GAPPLICANT & PARENT: Read and sign the following agreement:
If awarded any scholarship, I shall enroll at the school I have indicated. I understand that any contemplated
change in my plans must be presented to the selection committee for approval. Such approval must be obtained
to enable me to qualify for my award. Amounts listed for scholarships are subject to change without prior
notice. Amounts listed may be based on prior year’s awards.
I also understand that all scholarships awarded at Commencement must be claimed in the fall (and/or spring,
depending on the specific scholarship) of that same year by sending, as proof of enrollment, a fees paid receipt
or a letter from the Registrar and my scholarship redemption form to the DDHS Student Services Office after
arriving at school in September (and/or January). Winners may request an exception to this policy, but must
make that request prior to the designated payment time. Winners will relinquish their right to the scholarship if
they fail to comply with this requirement.
Applicant Signature
Date
Parent Signature
Date
NOTE TO APPLICANT: Return your completed application to the Student Services Office by 3:00 p.m. on
Thursday, April 16, 2015. Your counselor will complete the following information:
1.
The applicant ranks ____________ in a class of ______ (7 semesters).
2.
Applicant’s cumulative grade point average _____________________ (7 semesters).
The School District of Delavan-Darien does not discriminate against pupils on
the basis of sex, race, religion, national origin, ancestry, creed, pregnancy,
marital or parental status, sexual orientation or physical, mental, emotional
or learning disability in our local financial aid program.
*Reminder: All scholarship money received must be reported as income on state and federal taxes.