2017 Application for All BCSC Scholarships

The Baraboo Community Scholarship Corporation (BCSC) administers the scholarships listed below.  By completing this one form, you will be considered for all scholarships matching your qualifications.  The full description of each scholarship is detailed in the BCSC Scholarship Book 2017 (Student Version), located in the BHS Student Services office or on the BCSC website:  www.barabooscholarships.com.  

American Association of University Women (AAUW)
 Scholarship*
AAUW Irene Clausen UW—Baraboo Returning Student Scholarship
Joyce Albert Music Scholarship
Baraboo Breast Saver’s Scholarship
Baraboo Class of 1955 Scholarship
BHS Class of 1983 Memorial Scholarship*
Baraboo Community Scholarship Corporation Scholarship
Baraboo Education Association Scholarship
BHS High School Food Service Program Scholarship
Baraboo Kiwanis Robert C. Dewel Memorial Scholarship
Baraboo Kiwanis Harlan Lambert Memorial Scholarship
Baraboo Kiwanis Ron LaMasney Memorial Scholarship
Baraboo Masonic Lodge No. 34, F.& A.M. Scholarship*
Baraboo Citizens Police & Fire Academy Alumni Association Scholarship*
Baraboo Rotary Club Scholarship
Olga Marie Bassett Biological Sciences Scholarship
Bekah Kate’s Women in Business Scholarship
William Benzies, Jr. Scholarship*
Daniel D. Busch Memorial Scholarship*
Genevieve Caflisch Memorial Scholarship
Wendy Sue Cahoon Scholarship*
Bonnie Carroll Memorial Scholarship*
Elva Staveness Christopher Memorial Scholarship*
Cole Scholarship
Ruth E. Cranston Scholarship
Dells Area Cruisers Car Club Scholarship*
Devil’s Lake Concession Scholarship
Devil’s Lake Concession Employee Scholarship
Baraboo Chapter #21 Order of  the Eastern Star*
L.H. Eckhardt Memorial Scholarship by Chester Bible*
David Etzwiler Memorial Scholarship
Suzanne Schaefer Fischer Memorial Scholarship
Dina and Paul Fishkin Scholarship*
Mike Ford Memorial Rotary Scholarship*
John and Esther Gray Scholarship*
Teri Hanners-Fox Scholarship*
Ron Hart Memorial Scholarship
Lowell Haugen Memorial Scholarship
Lisa Holh Memorial Scholarship*

Sarah Holm Memorial Scholarship
Hollenbeck Scholarships*
Harry Jantz Memorial MATC Scholarship
Kasper Memorial Medical Scholarship*
Dave and Sherry Koepp Family Scholarship*
Baraboo USBC Bowling Association Keith Koepp
	Memorial Scholarship*
Kim Kropp Blum Sports Leadership Scholarship*
Judy Kuter Scholarship for Teacher Education Scholarship
Wilma Leonard Memorial Scholarship
Shirley & John Liebig Memorial Scholarship*
Tom & Glenyce Luck Scholarship*
George McArthur Memorial Scholarship*
Timm B. Meyer Memorial Scholarship*
Henry C. and Corwin G. Moeller Scholarship*
Sue Mossman Memorial Scholarship
Moy Borchert, Erbs CPAs Scholarship
Emil & Virginia Mueller Memorial Scholarship
Nessler Scholarships
Margaret Nessler Scholarship
North Freedom Rod, Gun and Archery Club Scholarship
Dick and Audrey O’Brien Memorial Scholarship*
Mike O'Connell Writer's Scholarship
Baraboo Lions Club—Zachary Onikul Memorial Scholarship
Kathy Ott Memorial Scholarship*
Parshall-Cummings VFW Post 2336 Scholarship
Prairie Clinic Scholarship
Lillian M. Radtke Memorial Scholarship
William A. Radtke Memorial Scholarship
Chris Rector Memorial Scholarship
Sarahan Family Scholarship
Gerald and Gladys Scott Memorial Scholarship*
Colin Smyth Memorial Scholarship*
Gerry & Bonnie Stadler Scholarship*
David & Denise Statz UW Platteville Engineering Scholarship
Russell R. W. Wettstyne Scholarship
Gordon & Sarah Willson Memorial Scholarship*
John B. Young Scholarship*
Nancy & Roger Ystad Scholarship*
Tanner Zimmerman Memorial Scholarship

*These scholarships include financial need in their criteria.  If you wish to be considered for any of them you must complete and return the official FAFSA SAR (Student Aid Report) with your application.  The FAFSA application is available online at:  www.fafsa.ed.gov Make sure you submit your actual financial information and not a certificate stating that you completed the FAFSA Form.  Applications with incomplete or missing financial information will not be considered for any scholarships requiring financial need.  (PLEASE NOTE:  After you complete the FAFSA form, it may take several days to get a “pin number” and “process” your application.  Please plan accordingly.)

You will be considered on the basis of this application, your references and your transcripts.   Please prepare the application carefully by typing or printing clearly in black or blue ink.  Answer each question as completely as you can, adding pages if necessary.  At the same time, please be concise.

This application, including your references (one school-related and one non-school-related), and transcripts from Baraboo High School and College (if applicable) must be postmarked and mailed to BCSC at P.O. Box 380, Baraboo, WI 53913-0380 or returned to the BHS Student Services Office no later than Tuesday, February 28, 2017  .  Incomplete applications, those bearing insufficient postage, or those postmarked/turned in after February 28, 2017 will not be considered.

Date of Graduation from BHS:	     	
Date this application is submitted	     	

1.	Personal Data

A.
	Name:	     	
B.	Street Address:	     	
C.	City, State ZIP:	     	
D.	Phone:	     	
E.	Email:	     	
F.	Father/Guardian Name:	     	
G.	Address:	     	
H.	Phone:	     	
I.	Mother/Guardian Name:	     	
J.	Address:	     	
K.	Phone:	     	
L.	Father's Occupation:	     	
M.	Employer:	     	
N.	Mother's Occupation:	     	
O.	Employer:	     	
P.	Names & ages of other dependents in household
(Be sure to include other children in college):	     	

The following questions relate to the criteria of specific scholarships (please select only one answer for each question):
Are you a citizen of the United States?	Yes           No	
What is your sex?	Male         Female	
What is your heritage?
	African/American    Caucasian    
Hispanic                   Other:  List:       
	
Do you have diabetes?	Yes           No	
Do you have a disability as defined by the WI Dept. of Public Instruction?	Yes           No
If yes, define:      	
Have you participated in the special education program?	Yes           No	
If you are a current college student are you enrolled full or part time?	Full-time   Part-time    Not a college student	
Will you be a full or part time student at the college level next fall?	Full-time   Part-time    	
How many college credits have you earned?	     	
Have your earned a degree from U.W. Baraboo?	Yes            No	
Have you completed at least 12 credits at U.W. Baraboo after graduating from BHS?	Yes            No   	
Have you ever participated in a bowling league?

	Yes            No	
Were you ever a member of the Baraboo Youth Bowling Assn.?  If so, list the years you were a member.	Yes            No
If yes, list years of membership:       	
Do you have a parent or guardian who is a member of
The Baraboo USBC Bowling Association?	Yes            No
If yes, list name(s):       	
Have you ever held a job or volunteer position working with the elderly?	Yes           No	
Did you work on the BHS yearbook?	Yes           No	
Have you completed Hunters’ Safety	Yes           No	
Are you a member of National Honor Society?	Yes           No	
Are you a current member of Key Club?
If yes, how many years have you been a Key Club member?	Yes           No

     	
List any leadership positions you’ve held in Key Club:	     	
Have you or a close friend or family member suffered from Breast Cancer?	
Yes           No
If “Yes”, please describe how this affected your life on an attached sheet of paper.	
Do you have a parent/guardian who is a member of Rotary?	Yes           No
If yes, list name(s):       	
Was either parent a member of the BHS Class of 1983?	Yes           No
If yes, list name of class member:       	
Have you ever been a member of the BHS band?  If yes, list the years/bands you participated in.	Yes           No
If yes, list years/bands you were a member of:       	
Have you ever been a member of the BHS Cross County Team?  If yes, list the years you participated.	Yes           No
If yes, list years you participated in Cross Country:       	
Have any family members ever been a member of AAUW (American Association of University Women)?	Yes           No
If yes, list name(s):       	
Are you a current member of Interact Club?	Yes           No	
Have you ever been a member of Interact Club?	Yes           No	
If yes, how many years have you been an Interact club member?	     	
List any leadership positions you’ve held in Interact Club:	     	
Do you have a parent or family member who has worked for McArthur Towels?	Yes           No	
If yes to McArthur Towel question, who, and what relation were they to you?       

Are you the son, daughter, grandson or granddaughter of a military veteran?	Yes           No
If yes, please name veteran and briefly describe his or her military experience (attach a separate sheet if necessary):       
	
Do you have any relatives who were/are Masons?  	Yes           No
If yes, list name(s):       
     	
Are you or have you been a member of FCCLA?	Yes           No
If yes, describe your activities/offices held:       
	
Have you participated in Prostart?	Yes           No
If yes, describe your activities/awards received:       
	
Are you a current or past employee of Devil’s Lake State Park?	Yes           No
If yes, list dates of employment at Devil’s Lake State Park:       
	
Are you physically challenged?	Yes           No
If yes, please describe your disability and include any athletic activities you’ve participated in:       
	
Comments (for any question above):     	

2.	Education
Transcripts of all high school and college courses are required.  Be certain to request these items early because applications submitted without transcripts will not be considered.

List all high schools and colleges attended (including any college courses taken while in high school):
Name of School/Location (City, State)	Dates Attended	Credits Earned	
     	     	     	
     	     	     	
     	     	     	
     	     	     	
3.	List major awards received and dates you received these honors.
     	

4.	List major hobbies.
     	
5.	 Describe your work history beginning with most recent job first.
Employer	Job Title	Hours Per Week	Period Worked	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	

6.	List your major extra-curricular activities (both in and out of school) and volunteer history during the last four years.
Organization	Activity/Any Office(s) Held	Hours per Week	Years of Participation	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
7.	What is your intended major and/or career?  Why?
     	

CURRENT GRADUATES ONLY       (PAST GRADUATES SKIP TO QUESTION  #11):

8.	Where do you plan to go to college?  Why?
     	

9.	Why do you want to go to college?
     	

10.	Give an example of an experience that has helped lead you to educational success.
     	

PAST GRADUATES ONLY      (CURRENT GRADUATES SKIP TO QUESTION 15):

11.	   Explain how your current college or the one you next plan to attend is/will be a good fit for you:
     	

12.	How have your reasons for attending college either changed or remained the same since beginning your studies:
     	

13.	Please describe your activities since graduating from Baraboo High School (i.e., employment, education, military service, volunteer work, personal situation).
     	
   
14.	   Since graduating from high school, relate an experience which enhanced your future career goals:
     	

ALL APPLICANTS:  

15.	What do you anticipate your schooling costs will be for the coming year?
Tuition	     	
Room & Board	     	
Books & Fees	     	
Total:	     

16.	What is the basis for your estimate?  (Give the name and date of the college catalog or other source.)
     	

17.	Have you been notified that you are to be awarded any other scholarships or grants?  If so, please give name, date, and amount.
     	

18.	Have you received any scholarships in the past?  If so, give name, date, and amount.
     	

Please list the names, signatures (preferred—however, if the reference is not local and a signature is not easily obtained, please explain), business telephone numbers, and e-mails of the two adults whom you are asking to complete reference forms for you.  They must not be related to you and they must know you currently.  One must be school-related and one must be a non-school-related person (i.e., employer, minister).  If you are presently in college, please try to have at least one reference represent your college—either a teacher or supervisor. As a courtesy to your references, BCSC suggests you provide each reference with an addressed, stamped, standard business envelope.  Please remind your references by word or telephone a few days before the application due date.  A missing reference could mean denial of a scholarship.  

	Name & Position	Signature (preferred)	Business Phone AND e-mail Address	
Non-school-related	      		     	
School-related	      		     	

Transcripts for your high school and college work are required.  If they are not postmarked by February 28, 2017 and mailed to BCSC at P.O. Box 380, Baraboo, WI  53913-0380 your application will not be considered.  Requesting transcripts is your responsibility and not that of the BHS Student Services office.  When you go to the Student Services office to request your transcript, they will require written permission to release it.  If you are 18 or over, your signature is sufficient.  If you are under 18, the signature of your parent or guardian is required.

I certify that the information contained in this application is correct.

I further certify that I will notify the BHS Student Services office if I am told by Honors Night of any other scholarship that I may be awarded.  FAILURE TO DO SO MAY RESULT IN THE FORFEITURE OF MY SCHOLARSHIP.  

I also agree that, if I am awarded a scholarship through BCSC and decide not to go on to school, I will notify BCSC in writing by JULY 1, 2017 at P.O. Box 380, Baraboo, WI  53913-0380.  This will allow an alternate to be selected for a scholarship.

Student Signature: ______________________________________ Date:  _     _______

Please submit this form to BCSC at P.O. Box 380, Baraboo, WI  53913-0380 postmarked by Feb. 28, 2017 or
return it to the BHS Student Services Office by the end of the school day on Tuesday, Feb. 28, 2017.

BCSC Application Financial Statement
(Must be completed to be considered for ANY scholarships with a Financial Need Requirement.)
All information is kept strictly confidential.

If you are interested in being considered for any scholarship administered by BCSC that has a financial need requirement, you must complete and return the standard FAFSA Form.  Scholarships that have a financial need requirement are identified with an “*” symbol on the first page of this application.  Please review this list.

If you do not complete a FAFSA form, you WILL NOT be considered for any scholarship with an “*” symbol.

The FAFSA Form is available online at:  http://www.fafsa.ed.gov/ .  You will need data from either your 2015 or 2016 Federal Income Tax return.  After you complete your worksheet it will take the agency several days to process your information before you can print your official SAR (Student Aid Report).  You MUST provide BCSC with a copy of your official SAR.  A certificate stating that you completed the FAFSA Form is not acceptable.

Make sure you follow all directions carefully and provide all requested information or your submission will be disqualified.

(PLEASE NOTE:  After you complete the FAFSA form, it may take several days to get a “pin number” and to “process” your application.  You will need two PIN codes—one for the parents and one for the student.  You can apply for your PIN codes at any time.  You may want to do this immediately.  These special PIN codes are needed to PRINT your official SAR.)

QUESTIONS?  Email BCSC at barabooscholarships@gmail.com.

2017 BCSC Scholarship Application
FINAL CHECKLIST

Please review and complete this checklist.  Attach it to the front of your completed application.

NAME:	     	
ADDRESS:	     	
PHONE NUMBER:	     	
e-mail:	     	

	My application is filled out completely and all required pages are attached in the correct order.
	[ORDER:  Checklist, Application, Transcripts (HS then College), FAFSA Form (if applicable), 
	References (if given to you)],

	My transcripts are attached.
	  Baraboo High School Transcript
	  College Transcript(s)—only if applicable

	My transcripts are coming under separate cover.  Who do we contact if they’re missing?
	     

	I am applying for BCSC Scholarships with financial need requirements.
	My completed FAFSA SAR (Student Aid Report) is attached
	I am NOT applying for BCSC Scholarships with financial need requirements.

	I have requested references from two adults (one academic/one non-academic).
		References are coming under separate cover.  Please list an easy way for us to contact
		your references if they are missing:
	
Reference Name (please print/type)	Contact Information (phone # and/or e-mail)	
     	     	
     	     	
	
		Some references are attached and some are coming under separate cover.
		Please list contact information above for any references that are not attached.
		All of my references are attached.

	I have SIGNED all of my submitted documents.

	If mailing, I will affix the correct amount of postage to my submission and I will make sure I mail to:
			BCSC
			P.O. Box 380
			Baraboo, WI  53913

	My submission will be postmarked ON OR BEFORE Tuesday, February 28, 2017 or returned to the BHS Student Services Office by the end of the school day on Tuesday, February 28, 2016.

SIGNED:  __________________________________________  DATE:       ___

BCSC Reference Form 2017
(Application Deadline is February 28, 2017.  NOTE TO BHS Staff:  Completed BCSC Reference Forms may be returned to the BHS Student Services Office before the end of the school day on Tuesday, February 28, 2017)

Name of Applicant: _     ___

The above named student has given your name to us as a reference for help in evaluating a scholarship application.  Any insight based on your experience that would aid us in our consideration and help us to distinguish this applicant from others would be appreciated.

Please be specific and frank as possible, yet concise.  You need NOT list the applicant's activities, grades or future plans.  Those are reported in the application form.  All information will be held in strictest confidence.  If you’d like to review the application the student is completing, click on this link:  2017 BCSC Application.

Make sure the student gives you a completed copy of the “Request for a Letter of Recommendation” form.  Use this information to personalize the recommendation.  Try to add details about the student in the area in which you know them.  Keep in mind that you make this student a “real person,” and not just a letter in front of the selection committee.

Finally, it is your recommendation that provides true insight into who this young adult is—give specific examples and not broad generalizations that are true of most teens.  If you say the student is responsible, give a specific example to illustrate your point.

	Below
Average	
Average	Above
Average	
Excellent	
Outstanding	
Scholarship						
Leadership						
Adaptability						
Initiative						
Reliability						
Integrity						
Self-discipline						

How do you know the applicant?  If teacher or coach, give the subject; if employer, the company.  Please include length of time you have known the applicant and any additional comments.
     	

Signature: _____________________________________________ Date _     ___
Type Name: _     ___
Place of Employment and Position Held: _     ____
Business Telephone Number: _     ____ 		  
Email: _     ___