PAULDING COUNTY

INDEPENDENT INSURANCE AGENTS

ASSOCIATION, INC.

SCHOLARHIP APPLICATION

ANTWERP INSURANCE AGENCY

FOLTZ INSURANCE AGENCY

HORNISH FINANCIAL & INSURANCE SERVICES, INC.

STAHL-STOLLER-MEYER INSURANCE CENTER

WILLIAMSON INSURANCE AGENCY

PAULDING COUNTY

INDEPENDENT INSURANCE AGENTS

ASSOCIATION, INC.

SCHOLARSHIP RULES & REGULATIONS

To be eligible for the Paulding County Independent Insurance Agents Association, Inc. Scholarship Award, the following provisions will govern the acceptance of applicants from the local schools as well as applicants in the home school system.

  1. Applicants must be graduating seniors who have all basic credits for college or *propervocational/technical school entrance.
  1. Applicants must be a son, daughter or legal ward of a Paulding County Ohio resident and graduating from one of the Paulding County school/home school systems.
  1. Applicants must have a current career average of “B” or better and be enrolled in an accredited college or *proper vocational/technical school of the student’s choice. Applicants enrolled in an accredited school of nursing working toward a degree are also eligible applicants.
  1. A Cumulative grades transcripts from each applicant, as well as a current G.P.A. must accompany each form.
  1. A Current A.C.T. score will be considered also, and must accompany each form.
  1. The number of applicants per school is not limited. At least one finalist will be awarded per school.
  1. Members of immediate families and persons residing in the households of Agents or Agencies’ employees are not eligible to participate in this award process.
  1. Applicants are to complete the “Scholarship Application Form” furnished by the P.C.I.I.A.A., Inc. Scholarship Committee by typing or hand printing. Section One, Section Two, Section Three, and Reference may be completed (using like headings) on separate paper(s) other than the official application form and then attached to the application form for mailing.
  1. All scholarships must be accepted initially in the next semester or quarter after proof of enrollment (furnished by the student recipient) is received by P.C.I.I.A.A., Inc. and the Scholarship Committee. In the event a student is unable to fulfill his/her enrollment obligation under this program, the Award is forfeited and the President of the P.C.I.I.A.A., Inc and the Scholarship committee may reassign the Award.
  1. Scholarship Awards will be presented at the Senior Awards Ceremonies at the respective high schools in May, or mailed directly to the home school system student(s) in May.
  1. Applications should be delivered back to the guidance office to be mailed/delivered directly to the address provided before the DEADLINE DATE OF MONDAY, APRIL 21, 2014.

Abby Hornish, Scholarship Chairman

Hornish Financial & Insurance Services, Inc.

23035 Road 140

Oakwood, OH 45873

Phone: 419-594-3866 or 800-949-2630

Proper vocational/technical means “schooling beyond high school where credits can be transferred to an accredited four-year college/university”.

PAULDING COUNTY

INDEPENDENT INSURANCE AGENTS

ASSOCIATION, INC.

SCHOLARSHIP

APPLICATION FORM

Please type or hand print information:

DUE: MONDAY, APRIL 21, 2014

NAME:______PHONE NUMBER:______

PARENT(S) OR

GUARDIAN(S) NAME(S)______

FatherMother

ADDRESS: ______

Street/RoadCityStateZip Code

AGE: ______DATE OF BIRTH ______SEX ______

NUMBER OF INDIVIDUALS IN IMMEDIATE FAMILY (including you) ______

BROTHERS: ______SISTERS:______

ACCREDITED COLLEGE, UNIVERSITY OR TECHNICAL SCHOOL WHICH YOU ARE INTERESTED IN ATTENDING: ______

PLANNED MAJOR COURSE OF STUDY OR DEGREE: ______

CURRENT G.P.A. ______cumulative grade transcript MUST be attached to this form.

CURRENT A.C.T. SCORE ______MUST be attached to this form.

SECTION ONE: (School Programs throughout high school)

List “activities” in which you have participated during your high school attendance (class officer, plays, athletics, music, etc.). Include years (Freshman, Sophomore, Junior, Senior) when active. Add “remarks” (individual awards, recognition, etc.) where appropriate. (Continued on next page also.)

ActivityYearsRemarks

______

ActivityYearsRemarks

______

SECTION TWO: (Non-School Programs throughout high school)

List memberships in “organizations” in which you have participated during your high school attendance. (4-H, church groups, etc.). Include “years” (Freshman, Sophomore, Junior, Senior) when active. Add “office held” (secretary, advisor, etc.) where appropriate.

OrganizationYearsOffice Held

______

SECTION THREE: (Additional activities during high school)

List all other activities during your high school years (including work experiences) NOT already mentioned which would fully describe your past achievements.

______

REFERENCE

(To be completed by an instructor in this year of school)

Evaluation of student: (leadership, perseverance, prediction of success at university, etc.)

______

______

(Signature)

Position:______

High School:______

SECTION FOUR:

  1. What are your career plans after completion of college/technical school?

______

  1. How will your career plans allow you to return to the Paulding County area? ( If not, please explain.)

______

SECTION FIVE:

  1. Have you applied for other scholarship awards? Yes _____ No _____

Type of Award:______

Donor: ______

  1. If you have been awarded scholarship assistance, please list:
  1. Type of award ______

Monetary Value: ______Donor: ______

  1. Type of award ______

Monetary Value: ______Donor: ______

STATEMENT OF APPLICANT, PARENT/GUARDIAN

We have examined this application and the records are true, complete and accurate.

Signed:______

(Applicant)

Signed:______

(Parent/Guardian)

Signatures are to be affixed prior to forwarding this application to the high school guidance counselor. An official grades transcript MUST be attached to this application form then returned to:

Abby Hornish, Scholarship Chairman

Hornish Financial & Insurance Services, Inc.

23035 Road 140

Oakwood, OH 45873