Franklin Lilly by DmbDcfA4



 Lilly Endowment Community Scholarship Program

                     offered through the

Providing scholarships to prospective college attendees
     possessing demonstrated character, academic and leader-
ship skills
                  to improve the Franklin County Community.
    Thanks to the generosity of Lilly Endowment Inc., two four-year college tuition scholarships are offered every year to
Franklin County residents through the Franklin County Community Foundation. The Lilly Endowment Community
Scholarship Program is designed to raise the level of educational attainment in Indiana and increase awareness of the
potential of Indiana’s Community Foundations.
    The scholarship is an honor, as recipients are known as Lilly Endowment Community Scholars. Since the inception in
1998, thirteen students have been named. They include: Jackie Betsch, Angel Bruns, David Buchta, Regina Day, Justin
Deutsch, Kristina Giesting, Andrea Meyer, Kylene Kaiser, Mitchell Pepper, Kristina Pittman, Susan Ritzi, Michelle Sams,
Heather Sottong, Brad Wendel and Michael Wessel.
    The program provides:
    Two scholarships for full tuition, required fees and a special allocation of up to $800 per year for required books and
required equipment for four years of undergraduate study on a full time basis leading to a baccalaureate degree at any Indiana
public or private college or university accredited by the North Central Association of Colleges and Schools.
     Lilly Endowment has established the following general criteria for its Lilly Endowment Community Scholarship Program.
Eligible participants:
       * Must be Indiana residents.
       * Will have graduated by the end of June 2005 with a diploma from an accredited Indiana high school.
       * Will pursue a full-time baccalaureate course of study (i.e., four-year program).
       * Will be entering college as a first semester freshman beginning in the fall of 2005.
       * Will attend an accredited public or private college or university in Indiana.
       * Have been accepted by that college.
       * Must be free to choose which Indiana College he/she will attend.
       * Will keep Franklin County Community Foundation, Inc. informed annually of academic status during college.
       * Will communicate with the Franklin County Community Foundation, Inc. as to educational or employment status for
         ten years following college graduation.
    In addition to the requirements set by Lilly Endowment Inc., the Franklin County Community Foundation has established
additional criteria for recipients.
       • Must be a resident of Franklin County who is not applying for a Lilly Endowment Community Scholarship from any
         other community foundation.
       • Must have a GPA of 3.5 or higher on a 4.0 point scale.
       • Must be willing to represent Franklin County and the Franklin County Community Foundation in a positive manner.

                                                SELECTION PROCESS
*PLEASE NOTE: Late applications and recommendations (postmarked after January 13, 2005 or received
in the office) will not be considered by the selection committee.
     To the parents, guardians and students regarding this scholarship application: Please be assured that all information will be
treated with the strictest confidence.
     A Selection Advisory Committee will review all applications turned in by the 1/13/2005 deadline. The Committee will
interview finalists February 12, 2005. The applicant(s) chosen to be Franklin County’s 2005 Lilly Endowment Community
Scholar(s) will be informed as soon as possible.
     The FCCF Scholarship Selection Committee is an independent committee of five members. The FCCF Executive Director
acts as a liaison between the FCCF Board of Directors, the FCCF Scholarship Selection Committee, applicants and Lilly
Endowment Inc. The FCCF Executive Director is not involved in the decision-making process. The committee is chosen to
represent a cross-section of Franklin County, including its professional and geographic constituents. Members have been
selected because they are perceived as well respected and objective.
Use the following checklist to be sure you have included all the information necessary to be considered for the scholarship.
    _____ Include a copy of the FAFSA printout and the provided release form.

    _____ Complete the application. Put five copies of your entire application flat (not folded) in a large envelope and send it to the FCCF
          office by January 13, 2005 (postmark date).

    _____ Give copies of the applicant appraisal to three adults. Ask them to complete the forms and insert into an envelope with a signature
          across the seal. Include the appraisals with your application.

    _____ Give your counselor the recommendation section. He/She will send it to the Foundation. The transcript requested from your
          counselor must include 2004, fall grades. A copy of your senior schedule must be attached.

    _____ If you would like to add more information for any question you are welcome to attach pages to this application.
Check off the space below to determine if you are eligible to apply.
     _____ I am an Indiana resident; I will have graduated from high school by the end of June 2005 from an accredited Indiana high school;
I have made application to pursue a full-time, four-year baccalaureate course of study beginning in the fall of 2005; if awarded the Lilly
Endowment Community Scholarship, I will attend an accredited public or private college or university in Indiana.
Financial Need Evaluation
     The analysis of financial need is one of many factors considered by the FCCF Scholarship Selection Committee. In an
effort to assess the financial need of applicants, the Foundation is requiring all students:
     1.   Go on-line to
     2.    On the first page, go to “Fill out a FAFSA”, complete the paperwork with your family’s income information and send.
           You may submit your FAFSA electronically without receiving a PIN number. The PIN number is used to sign the
           application electronically. Your completed FAFSA will be shown on the screen with your confirmation number. If
           your family’s 2004 tax information is not complete when you submit your FAFSA application, you still may submit
           the application with estimated numbers and adjust your numbers at a later date.
     3.    After sending the FAFSA information, you will receive a submission page. The Foundation only needs the page with
           your expected family contribution number (EFC). Print out the Submission Confirmation page with your Expected
           Family Contribution. Include only this page with your application.
     4.    If you have difficulty with this process, do not contact the guidance department at your school. Contact the Foundation
           office at (765) 647-6810.
     If you do not complete this step in the application process, the Scholarship Committee will not be able to completely
evaluate your application. We understand that the information you provide to the Federal Government on your FAFSA is
considered personal and confidential. The family estimated contribution will be the only financial information seen by the
selection committee and will be used only during the scholarship selection process.

                                                   APPLICANT SUMMARY
PHASE I                                                                    Criteria #6:    Letters of Recommendation
Criteria #1:    Academic Record           Measurement: 15 points                                                   Measurement: 5 points
Weight:         GPA on a 4.0 scale
                3.5 - 10 point 3.7 - 12 points 3.9 - 14 points             Criteria #7:    Financial Need             Measurement: 15 points
                3.6 - 11 points 3.8 - 13 points 4.0 - 15 points            Weight:         As indicated by the student’s estimated
                                                                                           family contribution on the FAFSA
Criteria #2:    Honors                  Measurement: 10 points
Weight:         National Honor Society & Awards                            PHASE II - Interview
                (Academic, community, athletic and work)                   Criteria #1:    SAT                       Measurement: 10 points

Criteria #3:    Leadership               Measurement: 15 points            Criteria #2:    Academics              Measurement: 15 points
Weight:         Demonstrated leadership in academics,                      Weight:         High GPA, Challenging academic courses
                athletics, community and/or work activities
                                                                           Criteria #3:    Appearance                Measurement: 25 points
Criteria #4:    Commitment               Measurement: 15 points            Weight:         Poise and presentation
Weight:         Commitment to a career and studies
                as demonstrated in the essay portion                       Criteria #4:    Essay                    Measurement: 25 points
                of the application                                         Weight:         Clear and concise with good ideas

Criteria #5:    Character              Measurement: 25 points              Criteria #5:    Activities              Measurement: 25 points
Weight          School, community and work experience                      Weight:         Work experience, leadership, volunteerism
                                                                                                  Application #_____________
                                                                             To be assigned by the Franklin County Community Foundation

             Franklin County Community Foundation Lilly Endowment Community Scholarship

                                                PERSONAL DATA

Please type or print all information. Neatness and clarity are important.

Applicant’s Name _____________________________________________________________________________________
                                      Last                          First                         Middle

Address ____________________________________________________________________________________________
                No.                  Street                  City                  State                           Zip

Township _____________________        Soc. Sec. # _____________________      Phone (             ) _____________________

Date of Birth ______________________

Are you a resident of Indiana? __________ yes   __________ no

Are you a resident of Franklin County? __________ yes   __________ no

High School _______________________________________           Year graduate(ed)(ing) __________

Family Information:

Father or guardian ____________________________________________________________________________________
                                       Name                                                      Phone No.

Address (if different from your own) _______________________________________________________________________

Mother or guardian ____________________________________________________________________________________

Address (if different from your own) _______________________________________________________________________

Name and address of employer of father, mother and or/legal guardian:

Name ___________________________________________             Name ___________________________________________

Employer ________________________________________           Employer ________________________________________

Employer Address _________________________________           Employer Address _________________________________

Length of Employment ______________________________         Length of Employment ______________________________
                                                                                                                Application #______________
                                                                                            To be assigned by the Franklin County Community Foundation

                                    LEADERSHIP AND CHARACTER CRITERIA
                                                            Work Experience

During your high school years did you work during vacations, outside of school hours or during summers? ___ No ___ Yes
If yes, during what years of school did you work? (See grid below.)

                    Dates of              Employer                      Number of          Duties                             Seasonal?
                    employment                                          hours worked
                                                                        per week

Senior              __________            _________________             _________          _______________                    ___________

Junior              __________            _________________             _________          _______________                    ___________

Sophomore           __________            _________________             _________          _______________                    ___________

Freshman            __________            _________________             _________          _______________                    ___________

                                                Leadership and Character Criteria
                  The scholarship selection committee will be evaluating the quality, not necessarily the quantity
                      of the following activities. Remember, you may attach additional sheets if necessary.

List in order of importance to you school activities or special projects in which you participated (indicate offices, years involved and
responsibilities held):

List in order of importance to you community service activities or community projects you have been involved with.

Do you believe distance or circumstances affected your participation in school activities? Please explain.

Is your high school academic record an accurate measure of your ability and potential? Please explain.

What personal values, beliefs and attitudes do you consider important as a leader? Why?

What have you done to make your high school and community a better place?

Have you ever been suspended, expelled or dismissed from school, or been on in-school suspension or out-of-school suspension during high
school? If yes, please explain.

Is there a situation in your past where your character was called into question? Please explain.
                                                                                                       Application #______________
                                                                                   To be assigned by the Franklin County Community Foundation

                                              AWARDS AND HONORS
List any awards or honors (academic, community, athletics, work) you have received in the past four years

                                            Award                                                                          Year(s)

_______________________________________________________________________________                                      _____________

_______________________________________________________________________________                                      _____________

_______________________________________________________________________________                                      _____________

_______________________________________________________________________________                                      _____________

_______________________________________________________________________________                                      _____________

_______________________________________________________________________________                                      _____________

Are you aware of any financial aid you will receive for your higher education? Please explain.

Has a sibling (brother or sister) received the Lilly Endowment Community Scholarship? ______________

Are you a first-generation college student? ______________

List the ages of other children living in your household: ________________________________________________________

Type or word process an essay of approximately 300 words describing your personal and educational goals including plans for
your career and your future. Do not include your name in the essay. In order to implement an objective selection process, a
number will be assigned to your application. Finalists will be required to write a short essay on a topic given to them by the
selection committee at the time they are personally interviewed by the committee.
                                                                                                       Application #______________
                                                                                    To be assigned by the Franklin County Community Foundation
_____________________________________________ affirms that:
Name of Applicant (please print)

     1. “If I receive this scholarship, it is my intent to pursue four years of undergraduate study on a full-time basis leading to
        a baccalaureate degree at an Indiana college.”
     2. “I understand that the total amount of my scholarship is calculated on the basis of my chosen college’s tuition and
        required fees beginning with the 2005-2006 school year.”
     3. “I will keep the Franklin County Community Foundation, Inc. apprized annually of my academic status during college
        and my post graduation status (education and/or employment) for at least ten years after graduation.”
     4. “I will account for and return any amount of the special allocation for required books and required equipment
        remaining at the end of each school year.”

Signed _________________________________________________ Date _____________

Applicant Name ____________________________________________________________

Address __________________________________________________________________

Phone No. ________________________________________________________________

MY KNOWLEDGE. If asked by any authorized official of the Franklin County Community Foundation, Inc. I realize that
failure to comply with a request for further information may prevent the applicant from receiving any aid.


________________________________________________                 __________________
Applicant                                                        Date

________________________________________________                 __________________
Parent/Legal Guardian                                            Date

________________________________________________                 __________________
Parent/Legal Guardian                                            Date

All parties involved in this application must sign this certification in order to have the application considered. The Foundation
shall reserve the right to withdraw the scholarship if the recipient should conduct himself/herself in such a manner that
would result in and reflect an unfavorable image upon the Foundation and the Lilly Endowment Community
Scholarship program. The applicant, if chosen as a Lilly Endowment Community Scholar, must sign the FCCF
Conditions of Retention to receive and continue in the scholarship program. The conditions include:
      1. Represent Franklin County and the FCCF in a positive manner.
      2. Submit all Book Stipend Reports, receipts, reimbursements, status reports, grade transcripts and essays by the
          established deadlines as supplied.
      3. Meet with the Foundation Board and staff for an individual appointment each year between May and August.
          upon, and at the time specified in, a notice provided to you by the FCCF staff.
      4. Participate in activities planned by Lilly Endowment Inc., and the FCCF for scholarship recipients, i.e., annual
          dinners, banquets, parades, etc.
      5. Engage in no illegal activities, including minor consumption of alcohol, including juvenile misdemeanor and
          felony offense.
                                                                                                      Application #______________
                                                                                  To be assigned by the Franklin County Community Foundation

                                             APPLICANT APPRAISAL

Student: Make three copies of this appraisal and distribute to three adults. One recommendation may be
completed by a school administrator or teacher and the remaining two from a community or religious
leader, employer or another person in a position of authority who knows you and your accomplishments.
Members of the FCCF Board of Directors and staff are not permitted to write appraisals. Remember to
collect the appraisal from the adults and include with your application.

Applicant’s Name

     Please give us your candid estimate of the following: the nature of the applicant’s intellectual qualities and academic
abilities, emphasizing both strengths and weaknesses; the applicant’s character and personal strengths and weaknesses; any
special talents or interests the applicant may have; and any additional observations that you believe would be relevant. We are
especially interested in any special circumstances or background information that might give us added insight as we consider
this application. You need not list activities, as the student will have provided us with such a listing in the application.
     Please limit your response to one page, typed, double-spaced, with no smaller than 10-point typeface. Attach this sheet to
the front of your response. Do not include the student’s name in your response, as the FCCF will attempt to preserve the
anonymity of the student during the initial review. However, please use the appropriate pronoun (he/she) when referring to the

Appraiser’s Name (please print) __________________________________________________________

Appraiser’s Signature ________________________________________ Title _____________________

Date ______________________________ Telephone _______________________________________

    Appraiser: Please insert your appraisal into a sealed envelope with your signature across the seal. Students must include
your appraisal with the application. Remember, the completed application is due to the Foundation by January 13, 2005
(postmark date). References submitted after the deadline date will not be considered by the committee.

                                                  Executive Director
                                      Franklin County Community Foundation, Inc.
                                         527 Main Street, Brookville, IN 47012

           References submitted after the deadline date will not be considered by the committee.
                                                                                                      Application #______________
                                                                       To be assigned by the Franklin County Community Foundation

      To be completed by Applicant’s High School Guidance Department


                       Applications must be postmarked by January 13, 2005.
                                         Executive Director
                             Franklin County Community Foundation, Inc.
                                          527 Main Street
                                        Brookville, IN 47012

Counselors: Please include a copy of this student’s secondary transcript, which must include

Feel free to send all application forms in a group package. This information is handled with great care to
insure the privacy of your student.

Student’s name _______________________________________________________________________________________
                        Last                                First                               MI

Name of high school ___________________________________________________________________________________

School address _______________________________________________________________________________________

High School CEEB Code ______________ Date of Graduation _______________________

Counselor’s name __________________________________________________ Phone____________________________


       Academic Performance:   Rank in class (9/150 format) ________ GPA _________

               SAT:    Verbal ________ Math ________

               ACT:    English ________ Math ________ Reading ________

                       Science Reasoning ________ Composite ________

Special academic program which student followed during high school:
                               21 Century Scholar              Yes _____ No _____

                               National Merit Finalist         Yes _____ No _____

                               Academic Honors                 Yes _____ No _____

                               Core 40                         Yes _____ No _____

                 Applications must be postmarked on or before January 13, 2005

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