Roger and Emily Benner Scholarship Fund for PaintValleyGraduates

In lasting memory ofRoger and Emily Benner, their daughters,Julia Perry, Norene Mapes, and Alma Jane Penwell have established annual scholarships to be awardedto qualified graduates of PaintValleyHigh School, Bainbridge, Ohioas funds are available.

Guidelines for Application

  1. Applicant must be a graduate of PaintValleyHigh School, Bainbridge, Ohio.
  1. Applicant must have not less than a “B” average (3.0 on a 4.0 grading scale).
  1. Applicant must provide proof of acceptance by the college, trade school, or technical school of his/her choice.
  1. Application must be accompanied by official high school transcripts and ACT or equivalent scores.
  1. Scholarship funds are to be used for general expenses: Tuition, room/board, and books.
  1. Scholarship payment will be made only to the designated educational institution.
  1. Should a student withdraw before completing his/her first year, the remaining funds, in accordance with the policy of the institution, shall be returned to the fund.
  1. Roger and Emily Benner were supporters of local 4-H programs, and preference will be given to 4-H members.

Applications should be returned to your guidance office or by mail or email to:

Chillicothe-Ross Community Foundation

45 E Main St

Chillicothe, Ohio45601

Roger and Emily Benner Scholarship Fund for PaintValley Graduates

Student Application Form

I hereby apply for a college scholarship and submit the following information.

Name: Date of Birth:

Address:

Phone #:

Social Security #:

Parent or Guardian: (father/stepfather)

Parent or Guardian: (mother/stepmother)

Number of younger brothers or sisters:

Number of brothers or sisters attending college:

High School Class Rank:

A.C.T. Composite Score:

Name and Address of College, University, or Trade School you plan to attend:

Name of Admissions Officer:

Phone & Extension # of Admissions Officer:

What College, University, or Trade School degree do you currently hope to achieve?

What Career/Field do you wish to enter with this degree?

Attachments

Please include the following attachments:

  • Proof of acceptance by the school of your choice
  • PaintValleyHigh school transcript
  • Two letters of recommendations from teachers, coaches, advisors, or other community leaders.
  • Write a listing of recognition you have received for outstanding schoolwork, i.e. honors, prizes, or scholarships.
  • List the activities in which you have engaged during your high school years. Include in the list organized out-of-school activities (4-H Club, scouting, church organizations, etc.) as well as those connected with school (class officer, music organizations, athletics, publications, etc.).
  • Self Expression Synopsis
  • Write an essay of at least 250 words, describing yourself; your interests, hobbies, and goals; and your church, school or community involvement.
  • Please include a picture or senior picture if available

Roger and Emily Benner Scholarship Fund for PaintValley Graduates

Statement of Proposed Budget for the Coming Year

Anticipated Sources of Income

Scholarship/Grants: $

Loans: $

Summer Work: $

Family Contributions: $

Other: $

Total Income: $

Estimated Expenses

Tuition & Fees: $

Room & Board: $

Books: $

Travel Expenses: $

Miscellaneous Expenses: $

Total Expenses: $

Roger and Emily Benner Scholarship Fund for PaintValley Graduates

I hereby certify that all statements contained in the foregoing application are true and correct, that I have read the description of the Roger and Emily Benner Scholarship Fund for Paint Valley Graduates, that I believe myself eligible to apply for a college scholarship under the provisions and conditions it contains, and I authorize my school to provide information to the Selection Committee upon request.

Signed: Date:

(Student)

This application and certification and release are true and correct and meet with my approval.

Signed: Date: (Parent)