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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