IPOC TUITION ASSISTANCE
2002-03 Calendar School Year
Illinois Protective Officials Conference
BOCA Chapter #13
-Established 1961-
SCHOLARSHIP FUND APPLICATION
FOR TUITION ASSISTANCE
PURPOSE
In an effort
to further the purposes of the Illinois Protective Officials Conference, this program is established to advance the educational
and training needs of its members, their families and others supporting safety in the built environment. The purpose of the scholarship is to provide tuition assistance to active and retired IPOC members and
their children, grandchildren and/or spouses, or to a member of the student chapter.
SCHOLARSHIP BENEFITS
Recipient(s)
will be awarded tuition assistance up to $500.
ELIGIBILITY CRITERIA
Applicants
must:
v Be scholastically responsible, with a cumulative grade point average of C or better at time of application.
v Have relative financial need for the scholarship.
v Submit the completed application form, including attachments I, II, III, and IV on or before July 1, 2003.
Applications must be submitted to:
Illinois Protective Officials Conference
C/o Troy Sondgeroth, 100 E. Phoenix Av.,
Normal, IL 61761
(309) 454-9583
ADMINISTRATIVE GUIDELINES
v Applications are available upon request. The committee will mail all
requested Scholarship Applications.
v Completed Applications, including Attachments I, II, III, and IV must be received by the committee by July 1, 2003.
v Selections will be made and recipients notified by the committee on or before August 1, 2003.
v Arrangements for forwarding the Scholarship to the recipients or institutions will be made at that time.
v Recipients may be announced in a news release. A photo may be requested.
v Grants and/or scholarships to be awarded to IPOC members, retirees or their children, grandchildren, and spouses annually
for higher education, annual conference attendance or other approved educational opportunity consistent with our profession,
shall not exceed 25% of the funds available. To qualify for this benefit the
member shall be of good standing and current with their dues. He/she must also
demonstrate that they will not be supported by the jurisdiction in which they are employed.
v In keeping with IPOCs support of the Illinois State University Student Chapter, members of the Construction Student
Chapter will be eligible for financial assistance.
v The selection committee will abide by the rules and regulations set forth by Article XIII of the IPOC Bylaws.
Illinois Protective Officials Conference
BOCA Chapter #13
-Established 1961-
SCHOLARSHIP APPLICATION
Applicant
Name_________________________________________________________
(Last)
(First)
(Middle)
Home Address__________________________________________________________
(Number and
Street)
__________________________________________________________
(City/Town)
(State)
(Zip)
Home Phone (
)
IPOC Member
(or student chapter) _________________________________________________________
(Name)
(Relationship
to Applicant)
_________________________________________________________
(Department Name)
Work Address__________________________________________________________
(Number and
Street)
__________________________________________________________
(City/Town)
(State)
(Zip)
Work Phone
(
)
List all
high schools, colleges, universities and trade schools you have attended:
Name of School
Dates Grade
Point Degree Earned
Attended Average
List all
employers, starting with the most recent:
Name
Address Job Title & Dates
Employed
List membership
in clubs, volunteer groups, etc.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Write the
complete name, address and phone number of the institution you plan to attend (utilizing this scholarship):
________________________________________________________________________
(Name) (Street)
(City/Town)
(Zip)
Phone Number
___( )__________________
Indicate
the field of study you have chosen to pursue:
________________________________________________________________________
Indicate
the term for which scholarship is sought:________________________________
Tuition cost:
$________________ per semester.
STATEMENT OF APPLICANT:
In applying
for consideration, I am aware that the scholarship is to be applied toward tuition only unless otherwise specified. In the event that my tuition cost does not equal the full amount of the scholarship awarded, I understand
that I will receive only the amount of the tuition.
If granted
a scholarship, it is my intention to remain a full time student (as defined by the institution) for the term(s) for which
the scholarship is applied.
I verify
that all information submitted is true and correct to the best of my knowledge.
_____________________________________________________________________
(Applicants Signature)
(Date)
ILLINOIS PROTECTIVE OFFICIALS CONFERENCE
SCHOLARSHIP FUND APPLICATION
Student Name:______________________________________________
(Last)
(First)
(Middle)
Student address:
_________________________________________________________
_________________________________________________________
Name and
address of high school or college issuing transcript:____________________________________________________________________________________________
High school
or college accredited by: _________________________________________
Dates of
attendance:
From _______________________ To ______________________
Cumulative
grade point average:
High School ____________ College____________
High school
class size: _____________________
Class rank of applicant: ___________
(Test scores and class
rank must be included. If final results are not available, base entries on most
recent information and estimated percentages.)
Counselor
/ Teacher remarks (Optional):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________ _____________________________
(Printed name of school official)
(Title)
_______________________________________________ ____________________________________________
(Signature
of school official)
(Date)
OFFICIAL COPY OF TRANSCRIPT MUST BE ATTACHED
STATEMENT OF FINANCIAL NEED
(Confidential)
Applicants
Name: _____________________________________________________
(Last)
(First)
(Middle)
Identify below all sources of scholastic aid available to you during the school
year for which the application is made.
A. Aid from parents $_______________
B. Personal savings, investments, trusts, etc. $_______________
C. Earnings, current calendar year $_______________
D. Social Security or Veterans benefits $_______________
E. Scholarships,
loans or grants applied for this Year $____________
F. Scholarships, loans or grants received in prior year not covered
by this application $____________
G Spousal earnings if applicable: $_______________
H. Aid from other relatives: $_______________
I. Other: $_______________
TOTAL: $_______________
The information requested will be used to determine relative need for financial
assistance. The Scholarship Committee will keep information provided confidential.
FINANCIAL AID FORM (page 2)
(Confidential)
Section A. Students
Identification Information
1. Applicants Name ____________________________________________________
(Last)
(First)
(Middle)
2. Address____________________________________________________________
(Number)
(Street)
____________________________________________________________
(City) (State) (Zip)
3. Social Security Number
- -
Date of Birth
/ /
Section B. Household Information
Parents____________ Information____________ Spouse____________
1. Number
of family members in 2002-03 (include yourself)____________
2. Number
of college students in 2002-03 ____________
Section C. 2002 Income, Earnings and Benefits
1. The following
2002 U.S. income tax figures are from a completed 2002 IRS Form____________
2. 2002 total
number of exemptions_____________
3. 2002 adjusted
gross income______________
4. 2002 U.S.
income tax paid_____________
5. 2002 income
earned from work by father (if applicable)______________
6. 2002 income
earned from work by mother (if applicable)______________
7. 2002 income
earned by spouse (if applicable)_______________
8. 2002 income
earned from work by student (if applicable)_____________
ILLINOIS PROTECTIVE OFFICIALS CONFERENCE
SCHOLARSHIP
REFERENCE FORM
(OPTIONAL)
Please complete
and return this form by July 1, 2003. If the scholarship applicant is currently
enrolled in school or working, it is requested that teachers or employers complete the reference form. Otherwise personal references (excluding family members) are acceptable.
RECOMMENDATION CONCERNING
____________
_________________
(Last)
(First)
(Middle)
Submitted by:
___________________________________________________________ (Name of reference)
Job title: _______________________________________________________________
Address: _______________________________________________________________
Daytime phone
number: ___________________________________________________
1. In what capacity have you come to know the applicant?
2. What are some qualities of this applicant that lead you to believe he/she merits a scholarship?
3. Do you know of any personal circumstances that might interfere with the applicants success as a student
or the proper utilization of the scholarship funds?
4. Additional comments:
Date___________________________ Signature__________________________
