Ivy Tech Community College of Indiana

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Ivy Tech Community College—Richmond Foundation Scholarship Application

Scholarships are awarded in July for the upcoming Fall and Spring semesters. The application deadline is June 1, 2008. YOU MUST BE ADMITTED TO THE COLLEGE FOR YOUR SCHOLARSHIP APPLICATION TO BE CONSIDERED. If you have not yet applied for admission to Ivy Tech Community College, click here.

Contact Information:

Last Name
First Name
Street Address
City
Zip Code
Home Telephone Number		(e.g. 123-555-1234)
County of Residence
Date of Birth		(e.g. mm/dd/yyyy)
Work Telephone Number		(e.g. 123-555-1234)

Education:

Credit Hours Completed		(e.g. 20)
GPA		(e.g. 2.5)
Program of Study Degree
High School Attended
I am a (check one):		Current H.S. Student New Ivy Tech Student Current Ivy Tech Student Returning Ivy Tech Student Attend Whitewater Technical Career Center (dual-credit student)
When do you plan to begin classes at Ivy Tech Richmond / Connersville? (e.g. Fall 2007)

Personal Data (optional):

Sex		Male Female
Race		African American Asian Caucasian Hispanic Native American Other
Do you have a disability? (Some scholarships give preference to applicants who have a disability.)		Yes No
Employment Status		Full-Time Part-Time Not Employed
Marital Status		Single Married Divorced Widowed
# of dependent children
Are you a single parent?		Yes No
Are you or a close relative a member of Eagles Lodge #666?		Yes No
Are you or a close relative employed by Ford or Visteon?		Yes No If yes, list employee’s relation to you.
Indicate for which scholarship(s) you are eligible and would like to be considered:
Accounting Scholarship Automotive Scholarship Eagles Scholarship Eva Blakemore Scholarship Ford / EEOC Scholarship Futures Unlimited Scholarship Clella Garrison Hanes Scholarship Harry & Marilyn Voyles Scholarship Idris Bond Smith Scholarship Joe & Roma Meyer Scholarship		Kenneth Morford Scholarship Minority Nursing Scholarship Minority Student Scholarship Monroe Memorial Health Scholarship Norman & Mary Johnson Scholarship Nursing Program Scholarship Paul & Pat Lingle Scholarship Poling Scholarship Pumerville Scholarship Stidham Family Scholarship
Why did you choose Ivy Tech - Richmond to further your education?
Why is receiving a scholarship important to you?
What are your career goals and ambitions following the compeltion of your degree?
Please list any additional information about yourself that you would like the scholarship committee to know: (jobs held, volunteer or student activities, awards, or honors received, hobbies and special interests, etc.

By submitting this form I give permission for Ivy Tech Community College of Indiana to release information to its selection committees so that I may be considered for scholarships and awards. If offered an award or scholarship, Ivy Tech has my permission to use my name and non-confidential information such as my residence, high school, and name of award in their promotional materials.

Changing Lives

Richmond Campus
2357 Chester Blvd.
Richmond, IN 47374
765-966-2656
800-659-4562
FAX 765-962-8741

Connersville Campus
717 West 21st Street
Connersville, IN 47331
765-825-9394
FAX 765-825-4516