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October 23, 2018

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Scholarship Application
Updated On: Feb 03, 2009

The IAFF Local 4143 Fallen Hero’s Scholarships are made possible by the Crawfordsville Firefighters Local 4143

I.A.F.F. LOCAL 4143 FALLEN HERO’S SCHOLARSHIP

 

 

The IAFF Local 4143 Fallen Hero’s Scholarships are made possible by the Crawfordsville Firefighters Local 4143, through Fundraisers and donations.    Scholarships are awarded on a one time, non-renewable basis.  Applicants will be chosen from a score sheet.  Special circumstances will be considered in the event there is a tie.  Scholarship awards may be applied toward tuition, books or room and board at an accredited college or university.  There will be two $500.00 scholarships awarded annually.  Applications have been given to the school counselors or they may be downloaded at www.iaff4143.org.

 

To be considered for the FALLEN HERO’S SCHOLARSHIP you must meet the following conditions:

 

1.                  You must graduate, or have graduated, from a Montgomery County High School or Montgomery County Home School.

 

2.                  You must have a 2.8 cumulative GPA on a 4.0 grade scale at the end of the last attended semester of school.

 

3.                  A direct family member must be a current or past member of an emergency service (fire, ambulance, or health related).  The exception to this is if the applicant is pursuing a degree in emergency services.  A direct family member is defined as father, mother, brother, sister, grandparent, aunt, uncle, or step parent. 

 

Your application will be complete when the following items have been received:

 

1.                  Completed Application (pages 3 through 6)

2.                  Official High School Transcript

3.                  Official College Transcript (If Applicable)

4.                  Official SAT and or ACT Scores

5.                  Special Circumstances Statement (If Applicable)

6.                  Two Letters of Recommendation (different from references)

7.                 Statement of Goals (please include this with application)

 

 

SPECIAL CIRCUMSTANCES

 

Special circumstances are defined as anything outside the student’s control that may affect his or her academic achievement.  Examples could be a serious illness or disability of a student or family member, traumatic event (House Fire, Loss of a Loved one, Accident), or other serious event.  There are other situations that may qualify as special circumstance.  If you feel that you have a special circumstance not listed in the examples, please explain your personal situation on a separate sheet of paper.  Please provide as many details as possible and attach it to the application.

 

Application deadline:  All applications must be received on or before April 1, of the year you are applying for.  No late applications will be accepted.

 

APPLICATIONS MUST BE MAILED TO: (cannot be hand delivered)

 

I.A.F.F. LOCAL 4143

Scholarship Committee

P.O. Box 69

Crawfordsville, Indiana 47933

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I.A.F.F. LOCAL 4143 FALLEN HERO’S SCHOLARSHIP

APPLICATION

(PAGE 3 THROUGH 6)

 

STUDENT INFORMATION

 

 

Last Name                                           First Name                               Middle Name

 

 

Home Address                                     City                                          State                Zip

 

 

Home Phone                                        Birth Date                     Age                  Sex ( M / F )   

 

 

E-Mail Address

 

 

 

-----------------------------------------------              Class Rank______ Out of _____

                High School                                     

                                                                                    GPA_________ on a _______ Scale

 

High School Diploma (Check One):                  Regular Diploma______________________

Core 40 Diploma______________________

Academic Honors Diploma______________

College G.P.A._______________________

 

 

 

S.A.T. Date Taken                               Math Score                           Verbal Score                  Composite Score

 

 

A.C.T. Date Taken               English Score     Math Score     Reading Score     Science Score     Composite

 

 

 

Name of College / University                             Major                                                     Minor

 

 

I will be a (Circle One):       Freshman       Sophomore         Junior          Senior         Graduate Student

                       

Please provide the following information regarding the parent (s), step-parent (s), or Legal Guardian who lives with the student listed above.

 

NAME, RELATIONSHIP TO STUDENT (Father, Mother, Legal Guardian), Home Phone, Work Phone, E-mail Address

 

 

Name                                       Relationship                                            Home Phone           Work Phone            E-Mail    

 

 

 

Name                                       Relationship                                            Home Phone           Work Phone            E-Mail

 

 

 

You must fill out line # 1 or line #2

 

#1 How are you a direct family member? _________________________

 

 

 

# 2 I am pursuing a degree in emergency services, (please explain):  ___

 

 

 

REFERENCES

 

List at least two references who could tell us something about you.  Examples may include a teacher, Minister, Work Supervisor or Family Friend, (references must be different from letters of recommendation).

 

 

Name                                       Relationship                                                      Phone

 

 

 

Name                                       Relationship                                                      Phone

 

 

 

Name                                       Relationship                                                      Phone

 

PLEASE FILL OUT EXTRA CURRICULAR ACTIVITIES NEXT TWO PAGES

 

EXTRA CURRICULAR ACTIVITIES

COMMUNITY ACTIVITIES AND VOLUNTEERISM, PLEASE LIST DATE STARTED AND THE DATE YOU FINISHED

 

 

ORGANIZATION                                DATE STARTED                    DATE FINISHED

 

 

ORGANIZATION                                DATE STARTED                    DATE FINISHED

 

 

ORGANIZATION                                DATE STARTED                    DATE FINISHED

 

 

ORGANIZATION                                DATE STARTED                    DATE FINISHED

 

 

ORGANIZATION                                DATE STARTED                    DATE FINISHED

 

 

ORGANIZATION                                DATE STARTED                    DATE FINISHED

 

 

WORK EXPERIENCE

INCLUDING SUMMER JOBS

 

 

 

EMPLOYER          POSITION                DATE STARTED                  DATE FINISHED               # HOURS WEEK

 

 

 

EMPLOYER          POSITION                DATE STARTED                  DATE FINISHED               # HOURS WEEK

 

 

 

 

EMPLOYER          POSITION                DATE STARTED                  DATE FINISHED               # HOURS WEEK

 

 

 

 

EMPLOYER          POSITION                DATE STARTED                  DATE FINISHED               # HOURS WEEK

 

 

 

 

EMPLOYER          POSITION                DATE STARTED                  DATE FINISHED               # HOURS WEEK

 

 

EXTRA CURRICULAR ACTIVITIES

 

 

 

HOBBIES

 

WHAT DO YOU LIKE TO DO IN YOUR SPARE TIME

 

 

 

 

 

 

 

 

 

 

 

 

SCHOOL ACTIVITIES

 

 

 

ACTIVITIES                           DATE STARTED                    DATE FINISHED                    ACCOMPLISHMENTS,

OFFICIES HELD, ECT

 

 

ACTIVITIES                           DATE STARTED                    DATE FINISHED                    ACCOMPLISHMENTS,

OFFICIES HELD, ECT

 

 

ACTIVITIES                           DATE STARTED                    DATE FINISHED                    ACCOMPLISHMENTS,

OFFICIES HELD, ECT

 

 

ACTIVITIES                           DATE STARTED                    DATE FINISHED                    ACCOMPLISHMENTS,

OFFICIES HELD, ECT

 

 

ACTIVITIES                           DATE STARTED                    DATE FINISHED                    ACCOMPLISHMENTS,

OFFICIES HELD, ECT

 

 

ACTIVITIES                           DATE STARTED                    DATE FINISHED                    ACCOMPLISHMENTS,

OFFICIES HELD, ECT

 

 

 

ACTIVITIES                           DATE STARTED                    DATE FINISHED                    ACCOMPLISHMENTS,

OFFICIES HELD, ECT

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