A valid application should include the following:
A completed application form
City (Zip) __________________________________________________________________
High School _______________________________________________________________
High School Principal Name _________________________________________________
Sport for which applying for scholarship: ______________________
List the sports and years the applicant participated ______________________________
List the letters received in each sport __________________________________________
Would this award impact any other financial award that you have already received?
College Preference and Area of Pursuit __________________________________________
By signing this form, I confirm the following:
1. I have remained substance free, and pledge to remain substance free, throughout my high school career
2. I have never been ejected from a contest for unsportsmanlike conduct
3. I have never violated my school’s code of conduct
4. I confirm that the information listed above is accurate
Student’s Name (print)_______________________________________
Student’s Signature _________________________________________ Date _______________________
Parent’s Name (print)________________________________________
Parent’s Signature __________________________________________ Date _______________________
I. ACADEMICS (attach certified transcript)
High School GPA (on a 4.00 scale) ________
Class Rank _____ out of a total enrollment of _______.
Does the school offer advance placement or honors classes?
Did the applicant enroll in these advance placement or honors classes?
If yes, is the applicant’s GPA weighted?
SAT/ACT Scores _______________________
II. EXTRA-CURRICULAR ACTIVITIES
Applicants: On this form, list the most significant out-of-classroom activities you have been involved in.
Those activities would include those which last through a sports season, semester, or school year, as opposed
to those activities which are conducted once a year on a single day or weekend. When listing awards, please
list the most significant awards in the comments area provided.
SCHOOL ACTIVITIES Grades Participated
9 10 11 12
COMMUNITY ACTIVITIES Grades Participated
9 10 11 12
EMPLOYMENT Dates of Employment
From To Comments
III. ADMINISTRATOR RECOMMENDATION
The member school principal or designee must submit a letter of recommendation for the student-
athlete who is applying for the IHSSDOF/INSKEEP Scholarship. Please address the student’s
character, sportsmanship, citizenship, leadership, and work ethic giving as concrete examples
when possible. This recommendation must be no longer than two pages in length, and no less
than a Times Roman 12 point font.
IV. COACH RECOMMENDATION
The coach must submit a letter of recommendation for the student-athlete who is applying for the
IHSSDHOF/INSKEEP Scholarship. Please address the student’s character, sportsmanship,
citizenship, leadership, and work ethic giving as concrete examples when possible. This
recommendation must be no longer than two pages in length, and no less than a Times Roman
12 point font.
V. Applicants must answer the following questions in the space provided:
A. Why is sportsmanship important in interschool athletics?
B. How has athletic participation contributed to your development as a productive
member of society?
C. Briefly discuss a challenge that you as an athlete or as a person have had to overcome
and how your participation in athletics helped you overcome this challenge?
The deadline for member schools to submit applications to the Hall of Fame Scholarship Chairperson is
April 1, 2011.
The mailing address for the HOF Scholarship Chairperson is:
Jay County High School
2072 West State Road 67
Portland, IN 47371