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					                              Community Foundation of Middle Tennessee, Inc.
                                                    Scholarship Program
Scholarships offered through The Community Foundation of Middle Tennessee have been made possible by the generosity of donors
who help students such as you plan post-secondary education. Scholarship Funds within The Community Foundation can be set up to
benefit students from particular geographic areas or schools, attending certain post-secondary institutions, or entering certain fields of
study. Students apply to the program and, if eligible, can be awarded grants from one or more of these different funds. Scholarship
applications are generally accepted and reviewed in the spring of each year.

             Instructions and Guidelines for Renewal Application for Past Recipients
Each scholarship fund has specific eligibility criteria which were defined by the donor when the fund was established. Please visit our
Web site www.cfmt.org/scholarships. We recommend you send your application and all of the supporting documents to us in one (1)
envelope.

    1.   Application
         Students who are reapplying for aid should submit the Renewal Application for Past Recipients. Applications must be
         complete to be considered. Include additional pages if necessary. Do not staple documents. Make sure all pages include
         your name and social security number. DO NOT apply for any scholarship for which you do not qualify. If you are
         applying for more than one scholarship, please copy and/or complete one (1) application per scholarship. Remember
         to make a copy of the application for your files.

    2.   Transcripts of Grades
         Students currently enrolled in college or vocational-technical school must include recent college transcript of grades from
         the last completed semester.

         If it is the policy of the school you attend not to give school records to students, then these records may come directly from
         the school providing they arrive before the deadline. If school records are not received by the deadline, the application will be
         considered incomplete and will not be reviewed. Web site generated transcripts or faxed transcripts are not official and are
         therefore unacceptable.

    3.   Student Essay
         Compose and complete the Student Essay page. Your essay must be typed or printed. In the statement, you should:
              Provide an update of your career goals and how your education plans will help you reach those goals.
              Describe how your college experience has changed your perspective of your career choice.

    4.   Financial Need
         Part of the criteria for scholarship aid is financial need. You will need to describe personal or family circumstances that
         make it necessary for you to seek aid for your education. To complete your application, attach a copy of the page from
         your Student Aid Report that shows Expected Family Contribution (EFC) as a result of filing FAFSA.

    5.   Additional Requirements
         Refer to each scholarship description for additional required materials.
              Applicants for the Genesco Scholarship, Archie Hartwell Nash Scholarship, Eloise Pitts O’More Scholarship, DBI
                  Scholarship, Col. Richard Dawson Scholarship, Jimmy Edwards Scholarship, William "Bill" Richards Scholarship,
                  Juliann and Joe Maxwell Scholarship, Tennessee Trucking Association Scholarship, or Turner Family Scholarship
                  must submit the appropriate verification forms included within the application.
              Applicants to the Drue Smith/Society of Professional Journalists’ Scholarship: Your student essay must focus on
                  the importance of journalism in the 21st Century. Please include a sample of your journalistic work.
              Applicants to the Robert Churchwell, Sr. Scholarship: Your student essay must focus on the role of professional
                  journalism in today’s society. Please include a sample of your journalistic work.
              Applicants to the Tennessee Trucking Association Scholarship: Your student essay must focus on the role the
                  trucking industry plays in the economic vitality of Tennessee.
              Applicants to the Davidson County Democratic Women/Shannon Wood Scholarship: Your student essay must
                  focus on “What policy or law in the United States would you change and why?”
              Applicants to the Walt Montgomery Scholarship: Your student essay should explain your educational plans and
                  how those plans will lead to a career in aviation.
              Applicants to the Student Education Loan Fund (SELF) should contact The Foundation for the appropriate loan
                  application.
                                                                                                                                         1
                                                                                                        Instructions & Guidelines
                                                                                                                          Page 2


6.   Notification of Awards and General Correspondence
     Notification of awards and other general correspondence related to this scholarship will be mailed to your permanent mailing
     address. Do not use your school address as announcements may arrive after the close of the school semester. Award
     approvals and denials will be announced by mail by mid-May.

7.   Application Timeline
     Your application, sealed appraisal letters, sealed transcripts and other supporting material must be received by The
     Community Foundation on or before March 15. Your transcripts can come directly from your school if it is the policy of
     that institution not to give official documents to students. Transcripts must arrive before the March 15 deadline. To ensure
     that your application is on time, you should request your transcript and appraisal letters before March 1. When mailing your
     application, be sure to allow sufficient time for delivery. It is important that ALL materials, including transcripts, appraisal
     form and financial information be mailed together with your application and/or arrive before the March 15 deadline.
     Materials received after the deadline are considered incomplete and cannot be reviewed. We are unable to accept faxed
     or e-mailed materials. Due to the number of applications we receive, we are unable to extend the deadline for any reason.

     Applications must be postmarked by the deadline. In the event that the deadline falls on a weekend, applications will
     be accepted until 4:30 pm on the first business day after the deadline.

     Please mail or deliver your application to:
     Scholarship Committee
     The Community Foundation of Middle Tennessee
     3833 Cleghorn Ave Suite 400
     Nashville, TN 37215

                                  Deadline for Applications: MARCH 15
                             For more information, visit our Web site www.cfmt.org/scholarship
                                or contact Ms. Pat Cole at (615) 321-4939 or pcole@cfmt.org




                                                                                                                                    2
                       SCHOLARSHIP RENEWAL APPLICATION
                             FOR PAST RECIPIENTS
                                                              Instructions
                                                  (Read very carefully and follow exactly)
Student Name
   Mr.   Ms.
                Last Name                                           First Name                                              MI

Please visit our Web site at www.cfmt.org for a complete description and full eligibility requirements of all the listed
scholarships before choosing the scholarship(s) you wish to apply for:

I am applying for the (mark all boxes that apply):

  Lt. Holly Adams Memorial Scholarship                                      Edna Martin Scholarship
  Kathy D. & Stephen J. Anderson Scholarship                                Katie Rose Martin Scholarship
  Baran Fine Arts and Music Scholarship                                     Juliann and Joe Maxwell Scholarship
  Belmont University Commercial Music Scholarship                           Juliann King Maxwell Scholarship
  George Oliver Benton Memorial Scholarship                                 John E. Mayfield ABLE Scholarship
  Dody Boyd Scholarship                                                     John E. Mayfield Scholarships for
  JoAhn Brown-Nash Memorial Scholarship                                        Cheatham Co. Central High School
  William and Clara Bryan Scholarship                                          Harpeth High School
  Cadiz Rotary Club/Rise Carol Thompson Memorial Scholarship                   Pleasant View Christian School
  Rachel Allison Cate Scholarship                                              Sycamore High School
  Leigh Carter Scholarship                                                  Eunice Lou Gower McHugh Scholarship
  Cheatham County Community Foundation Scholarship                          William Thomas McHugh and Lou Gower McHugh Scholarship
  Choose Your Future Scholarship                                            Walter Reece (Walt) Montgomery Scholarship*
  Robert Churchwell, Sr. Scholarship*                                       Carolyn Morrison Scholarship
  Howard A. Clark Horticulture Scholarship                                  Archie Hartwell Nash Memorial Scholarship*
  Community Bank & Trust Scholarship                                        Jerry Newson Scholarship
  Davidson County Democratic Women/Shannon Wood Scholarship*                Eloise Pitts O’More Scholarship*
  Colonel Richard M. Dawson Scholarship*                                    Buster Pool Memorial Scholarship
  DBI Scholarship*                                                          Barbara Hagan Richards Scholarship
  B. J. Dean Scholarship                                                    James Edward “Bill” Richards Scholarship*
  Jimmy Edwards Scholarship*                                                Wilbur C. Sensing, Jr. Scholarship*
  Genesco Scholarship*                                                      Ken Shipp Scholarship
  Pauline Gore Scholarship                                                  Drue Smith/Society of Professional Journalists Scholarship*
  Frank and Charlene Harris Scholarship                                     Richie Stevenson Scholarship
  A.D. and Peggy Hewlett and Colonel David R. Inman Medical Scholarship     Student Education Loan*
  Jennifer Ingrum Scholarship                                               Catie Summers Scholarship
  JubiLee Scholarship                                                       Technology Scholarship
  Maude Keisling/Cumberland Co. Extension Homemakers Scholarship            Tennessee Trucking Association Scholarship*
  Knox-Hume Scholarship                                                     Emmett H. Turner Scholarship
  Senator Carl O. Koella Memorial Scholarship                               Turner Family Scholarship*
  Michael B. Kruse Scholarship                                              Teddy Wilburn Scholarship
  Heloise Werthan Kuhn Scholarship                                          Woman’s Club of Nashville Scholarship
  Dr. Mac Scholarship                                                       John W. Work III Memorial Foundation Scholarship




*NOTE: These scholarships have additional requirements/supplemental forms to be completed at the end of the application. Please
make sure you complete the appropriate form and attach with your completed application.

                      Incomplete applications and applications that arrive after the deadline will not be reviewed.
                        DEADLINE FOR APPLICATION: MARCH 15 AT 4:30 P.M. CENTRAL TIME
                                                       Submit applications to:
                                                        Scholarship Committee
                                           The Community Foundation of Middle Tennessee
                                       3833 Cleghorn Ave Ste 400 – Nashville, TN 37215-2519
                                (615) 321-4939 office (888) 540-5200 toll-free Web Site: www.cfmt.org

                                                                                                                                          3
                                                  PERSONAL INFORMATION
                               Complete this application on a computer from our Web site at www.cfmt.org

Student Name
   Mr.   Ms.
                   Last Name                                       First Name                                       MI


Permanent Mailing Address (Award letters will be sent to your permanent address.)
Address
City                                          County                                      State                    Zip
Home Phone (include area code)                                   Work Phone (include area code)
Cell Phone (include area code)
Birthdate (mm/dd/yyyy)                      Social Security Number                          Gender                   Male       Female
Email address: for office use only by The Community Foundation staff

Ethnic Background: (Some scholarships are designed for specific ethnic groups. Please mark the category that applies to you. Your
response is optional.)
   African American/Black       American Indian/Alaskan            Asian                           Caucasian/White
   Hawaiian/Pacific Islander    Hispanic                           Other


MARK APPROPRIATE CHOICE
Level you will be entering in college:      Freshman            Sophomore                   Junior           Senior        Graduate Student
College/university you are attending or planning to attend:
Location of College/University:                   City                                                                 State
Main Campus or a Satellite Campus:              Main        Satellite (If satellite, list location city & state) City               State
Degree you will be pursuing:           AA      AS       BA         BS        MA              Graduate              Other
Field of study
Will you be enrolled:
   Full-time (12 hours or more)
   Part-time or more (6-11 credit hours)         How many hours are you taking?
   Less than half-time (Less than 6 hours)       How many hours are you taking?
Will you live:        on campus              off campus                  with parents             Other


ACTIVITIES/VOLUNTEER EXPERIENCE (attach additional sheet if necessary)
List all community and college activities in which you have participated during the past year. Include sports, student government,
volunteer projects, etc.

Activity                                                    How Long?                                     Special Honors
                                                               to
                                                                 to
                                                                 to
                                                                 to




                                                                                                                                              4
                                                            STUDENT ESSAY

Student Name                                                                                  Social Security Number

STUDENT INSTRUCTIONS: Compose an essay that provides an update of your career goals and how your educational plans will help you reach
those goals. How has your college experience changed your perspective of your career choice? Your essay will be a significant part of your
application, so please give it considerable thought. Use only the space provided below; NO HANDWRITTEN ESSAYS, PLEASE. Do not add
additional sheets.

Additional Instructions: For applicants to the Drue Smith/Society of Professional Journalists’ Scholarship, your essay must focus on the
importance of journalism in the 21st Century. Please include a sample of your journalistic work. For applicants to the Robert Churchwell, Sr.
Scholarship, your essay must focus on the role of professional journalism in today’s society. Please include a sample of your journalistic work. For
applicants of the Tennessee Trucking Association Scholarship, your essay must focus on the role the trucking industry plays in the economic
vitality of Tennessee. For applicants of the Davidson County Democratic Women/Shannon Wood Scholarship, your essay must focus on the
question “What policy or law in the United States would you change and why?” For applicants to the Walt Montgomery Scholarship: Your
student essay should explain your educational plans and how those plans will lead to a career in aviation.




                                            TRANSCRIPT AND SCHOOL RECORD
TO ALL APPLICANTS:
Students currently enrolled in college/university, SUBMIT A RECENT TRANSCRIPT of grades. Request your transcript early, it may take
several weeks. Web site generated transcripts are not official documents and therefore are not acceptable.

The School Official should enclose your transcript in a sealed envelope and sign the seal for security. Enclose the unopened envelope in the
completed application as you forward it to The Foundation. Your transcripts can come directly from your school if it is the policy of that
institution not to give official documents to students. Transcripts must arrive before the deadline or your application will be viewed as incomplete
and will not be reviewed.




                                                                                                                                                   5
                                             FINANCIAL AID ASSISTANCE QUESTIONNAIRE
Student Name                                                                                                           Social Security Number

INCOME, EXPENSES AND ASSET DATA
ALL APPLICANTS must complete the following financial information section. If the applicant is under 24 years of age and can still be
claimed by parent(s) for income tax purposes, parent(s) must complete the form as well.

                                                                                 STUDENT             PARENT/SPOUSE                  INDEPENDENT STUDENT                       TOTAL
1. Adjusted Gross Income, including Alimony (from last year’s
                                                                            $                       $                           $                                       $
   tax return)
2. Total US Income Tax Paid                                                 $                       $                           $                                       $
3. Untaxed Income & Benefits (social security, child support,
                                                                            $                       $                           $                                       $
   government assistance, etc.)
4. Cash Savings, Checking Accounts, Investments                             $                       $                           $                                       $
5. Home, if owned, assessed value                                           $                       $                           $                                       $
6. Current mortgage balance                                                 $                       $                           $                                       $
7. Rent                                                                     $                       $                           $                                       $
8. Business/Farm Value                                                      $                       $                           $                                       $
9. Business/Farm Debt                                                       $                       $                           $                                       $

Are you an independent student?              Yes     No (Students who are no longer claimed by parents for income tax purposes or students that are 25 years of age or older)
Applicant’s Current Marital Status:           Single    Married     Separated     Divorced      Widowed

What are the sources of financial support for this applicant’s educational expenses?:
Estimated Family Contribution $                              Federal and State Aid $        Other Scholarships/Loans $
Estimate yearly cost of college attendance:        Tuition $            Books/Supplies $          Room & Board $               Travel $
Are you eligible for the Tennessee HOPE Scholarship? Yes     No
Attach a copy of the page from your Student Aid Report that shows Expected Family Contribution (EFC) as a result of filing FAFSA.

Is this student currently employed? Yes                       No          If yes, please complete the following information:
Employer
Address                                                                                            City                                              State            Zip
Date of Hire                                                                                                      Position
Supervisor                                                                                                         Phone
Numbers of hours worked per week

FAMILY INFORMATION
Name of father/stepfather/guardian/spouse                                                             Phone
Address                                                                       City                                        State          Zip
Employer                                                                               Occupation
Name of mother/stepmother/guardian/spouse                                                             Phone
Address                                                                       City                                        State          Zip
Employer                                                                               Occupation
Check if applicable:    Father Deceased     Mother Deceased   Parents Married   Parents Separated     Parents Divorced       Single Parent
Number of dependent children in the home                  How many people in your household are attending college at this time, including applicant?
Did either parent graduate from college? No      Yes      Which one? Mother       Father
Part of the criteria is financial need. Describe personal or family circumstances that make it necessary for you to seek aid for your education. If you and your
family have unusual circumstances, such as illnesses not covered by insurance, unemployment, etc. that affect income, please include those as well.




CERTIFICATION: I/We certify that the information in this application is true and complete to the best of my knowledge. I/We understand that the financial information will be
considered confidential for review by the Board and Scholarship Committee of The Community Foundation of Middle Tennessee and any advisors it deems necessary pursuant to the Title V
Gramm-Leach-Bliley Act. I/We realize that this proof may include a copy of a U.S. tax return and/or state income tax return. I/We realize that failure to comply with a request for further
information may prevent the applicant from receiving any aid. I/We will supply any additional information The Community Foundation may request. Permission is hereby given to release
financial information requested for consideration with this scholarship application.

APPLICANT SIGNATURE                                                                                                                                  DATE

PARENT (SPOUSE) SIGNATURE                                                                                                                            DATE

                                                                                                                                                                                         6
                                              ACADEMIC APPLICANT APPRAISAL
Student Name                                                                                    Social Security Number

STUDENT INSTRUCTIONS: Have this section completed by a school administrator, counselor, dean, teacher or other person in a position
of authority who knows your academic accomplishments. Have him/her place the completed appraisal in a sealed envelope and sign the seal for
security. Enclose the unopened envelope in the completed application as you forward it to The Community Foundation. This form must be
completed by someone other than a family member.
Additional Instructions: For applicants of the Drue Smith/Society of Professional Journalism Scholarship and the Robert Churchwell, Sr.
Scholarship , have your Advisor or Chair of the Journalism Department complete the Applicant Appraisal below. For applicants of the Eloise Pitts
O’More Scholarship, please have the Chair of the Interior Design Department of O’More College Design complete the Applicant Appraisal below.

APPRAISER’S INSTRUCTIONS: Please write whatever you think is important about this student, including a description of academic and
personal characteristics. We are particularly interested in the candidate’s maturity, integrity, leadership potential, special talents, enthusiasm,
concern for others, respect accorded by faculty and reaction to setbacks that will help us to differentiate this student from others. Also include how
long you have known the student and in what context. You may attach a separate letter if you wish. Place the completed appraisal in a sealed
envelope and sign the seal for security. Return the sealed envelope to the student.
Additional Instructions: Appraisals for students applying for the Drue Smith/Society of Professional Journalists Scholarship and Robert
Churchwell, Sr. Scholarship, describe the student’s skills in journalism, significant works or activities such as internship or professional news
experiences. Appraisals for students applying for the Eloise Pitts O’More Scholarship, describe how the student is actively participating in
American Society of Interior Design (ASID) or International Interior Design Association (IIDA).




Ratings
Compared to others, how do you rate this student in terms of:
                                                                                     Good           Very Good                       One of the Top
                                                           Below                    Above           Well Above        Excellent    Few Encountered
 No basis                                                 Average     Average       Average          Average          Top 10%        in my career
               Academic achievement
               Extracurricular accomplishments
               Personal qualities and character
               Creativity, original thought
               Motivation
               Self-confidence
               Independence, initiative
               Intellectual ability
               Written expression of ideas
               Effective class discussion
               Disciplined work habits
               Potential for growth

I recommend this student:        With reservation         Fairly strongly        Strongly          Enthusiastically

Name                                                                            Title                                             Date
Organization
Address
City                                     State                        Zip                         Email
Signature                                                           Phone                                   Fax


                                                                                                                                                     7
                                               ATTENDANCE VERIFICATION
                                                       for the
                                             JIMMY EDWARDS SCHOLARSHIP
TO BE ELIGIBLE for the Jimmy Edwards Scholarship, you must have attended or graduated from the original Donelson High School, Donelson,
Tennessee, or be a descendant of alumni from Donelson High School.

To be completed by those applying for the Jimmy Edwards Scholarship. Please submit with completed application.

Student Name
                Last                                                          First                                         MI


Social Security Number



Please list the person(s) that connects you to Donelson High School:

                                                                       SELF/Relationship

                                                                            Relationship

                                                                            Relationship

                                                                            Relationship

                                                                            Relationship

                                                                            Relationship

                                                                            Relationship




                                                                                                                                      8
                                                 EMPLOYMENT VERIFICATION
                           STUDENT INSTRUCTIONS: Please complete the required employment verification below:

I am applying for the following scholarship:
    Colonel Richard M. Dawson Scholarship – To be eligible for the Colonel Richard M. Dawson Scholarship, you must be a child of an employee
of the Tennessee Highway Patrol who serves in uniform, undercover, or plainclothes.
   DBI Scholarship – To be eligible for the DBI Scholarship, you must be the child of a current employee of Ingram Entertainment, Inc. or DBI
Distributing Inc. with at least two years of service to the company.
  Genesco Scholarship – To be eligible for the Genesco Scholarship, you must be a child of an employee or be a current full-time or part-time
employee of Genesco, Inc.
    Juliann and Joe Maxwell Scholarship – To be eligible for the Juliann and Joe Maxwell Scholarship, you must be a child of a current full-time
or part-time employee of Tractor Supply Company. Employees must have a minimum of one year of service with Tractor Supply Company by
January 1 of the year in which the application is received.
    Archie Hartwell Nash – To be eligible for the Archie Hartwell Nash Memorial Scholarship, students must be a Middle Tennessee State
University sophomore or above, including graduate students, who are working a minimum of 20 hours per week and maintaining a 2.0 average or
better. Work Study does not count as employment.
    Tennessee Trucking Association Scholarship – To be eligible for the Tennessee Trucking Association Scholarship, you must be a dependent
child, spouse, or employee of organizations which are members in good standing of the Tennessee Trucking Association.
   Turner Family Scholarship – To be eligible for the Turner Family Scholarship, you must be a current full-time or part-time employee of Dollar
General. Applicants must have a no less than one year of service with Dollar General at the time of application.



Student Name
                 Last                                                First                                               MI

Social Security Number

Individual employed by company listed above:

Employee Name
                        Last                                                  First                                                MI
Company Name
Company Address and Department
City                                                                              State                                   Zip
Job Title                                                                                                        Date of Hire
Supervisor
Numbers of hours worked per week
Relationship to Applicant (example: mother, father, legal guardian or self)
Home Address
City                                                                              State                                   Zip
Home Phone (include area code)                                              Work Phone (include area code)

Parent/Guardian NOT employed by one of the companies listed above:

Name
        Last                                                 First                                                       MI
Address
City                                                                       State                                   Zip
Home Phone (include area code)                                           Work Phone (include area code)
Employer
Occupation
Relationship to Applicant




                                                                                                                                                   9
                                                    APPLICATION CHECKLIST

Student Name                                                                                          Social Security Number

                                               CERTIFICATION & SIGNATURES
In submitting this application, I certify that the information provided to The Community Foundation of Middle Tennessee is complete and accurate to
the best of my knowledge. Falsification of information will result in termination of any scholarship granted. I also certify that I have read the
instructions and will comply with all requests for documentation of my financial need, my transcripts, the status of other scholarship awards I
receive, or changes in my plans, should I receive a scholarship. I understand that The Community Foundation scholarships may only be used towards
the published cost of attendance at U.S. institutions. I certify that I am not related to any individual employed by The Community Foundation or
anyone who sits on the scholarship selection committee(s) for the scholarships for which I am applying. I understand this application is subject to
verification by The Community Foundation of Middle Tennessee at its discretion.

In submitting this application, I hereby give my educational institution permission to release information regarding any financial need and admission
status to The Community Foundation.


APPLICANT SIGNATURE                                                                                                            DATE


Press and Media Release
If selected to receive a scholarship, I authorize The Community Foundation of Middle Tennessee to use my name, likeness and any other
information, excluding financial information and social security number, in any media form and type of publication, including annual reports and
newsletters. I grant to The Community Foundation any and all rights to said use without compensation.

APPLICANT SIGNATURE                                                                                                            DATE

PARENT (SPOUSE) SIGNATURE                                                                                                      DATE
                                                            (if applicant is under 18 years of age)




                                                                 REMINDERS
Did you remember to:
    Indicate which scholarship(s) you are applying for?
    Complete and sign all pages of the application and all additional supplemental forms?
    Print or type your application?
    Include one (1) applicant appraisal sealed in an envelope?
    Include your official school transcript(s) sealed in envelopes?
    Spend time composing and writing your student essay?
    Include your financial statement, including parents’ finances where necessary?
    Include a copy of the page from your Student Aid Report that shows Expected Family Contribution (EFC) as a result of filing FAFSA?
    Remove staples from the application or attachments?
    Complete and sign the Application Checklist/Certification & Signature page?
    Make a copy of your application for your files?
    Assemble and mail your application(s) in one envelope before the March 15 deadline?




                                                                                                                                                   10

				
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