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  • scholarship

  • Just like most Midwestern families, the Mediacom family believes in the importance of higher education. As a corporation with strong community roots, we wanted to support, in some way, the higher education of our customers.

    For this reason, we formed World Class, a Mediacom scholarship program to help graduating high school students with their college expenses, such as tuition and books.

    Through the World Class program, Mediacom awards $1,000 scholarships to winning applicants.

    Scholarship Application ChecklistBefore you send your application materials to the address below, please make sure you have included the following:

    o Completed application with your signature and the signature of your school guidance counselor.

    o A copy of your high school transcript.

    o Your essay of about 500 words, typed and double spaced.

    o The references of two educators from your school (using the forms on the last page of this application).

    Retain a copy of the above documents for your records (except for the references).Incomplete packets will be automatically rejected.

    To be considered for a World Class scholarship, an eligible student must:

    1. Complete and include the application.2. Compose and include the requested essay.3. Include a copy of his or her high school transcript.4. Include references of two educators from his/her school.5. Mail all application materials postmarked on or before

    February 11, 2011.

    The selection of scholarship recipients is based on:

    Academic Achievement: demonstrated by high school grade point average information (GPA) and class ranking.

    Leadership: based on self-reliance, initiative and creative ability in school and out, as reflected in the applicant’s personal essay. Additional determining factors include:

    • Participation in school activities.• Honors received.• References of two educators from your school.• Participation in community activities.

    Completed application materials should be postmarked on or before February 11, 2011, and sent to:

    Mediacom World Class – The Mediacom Scholarship Program3737 Westown Parkway, Suite AWest Des Moines, IA 50266

    Questions may be sent to: [email protected]

    An Adobe Acrobat® format of the application can be downloaded at www.mediacomworldclass.com.

    Eligibility requirements:

    Children of directors, officers, employees or agents of Mediacom are not eligible.

    Applicants must be legal residents of a community that is being served by the North Central Division of Mediacom (see list on pages 6-7).

    Scholarship awardees may attend any accredited two-yearor four-year college, university, technical or vocational school within the United States.

    Applicants must intend to pursue a course of study at a qualified post-secondary institution.

    Applicants must be accepted by the qualified post-secondary institution prior to actually receiving a scholarship.

    Applicants must commence their post-secondary education or training in the first academic year following their senior year of high school.

    Applicants must be in their senior year of high school, must be high school graduates or persons who have achieved equivalent certification. If an applicant is awarded a scholarship while in his or her senior year of high school and does not graduate at the end of his or her senior year, he or she is no longer eligible to receive a scholarship.

    Students completing high school in less than the normal four years are eligible to apply.

    Students entering a qualified post-secondary institution in the middle of their senior high school year are permitted to apply the following year.

    All scholarships will be awarded without regard to race, religion, national origin, sexual orientation, political affiliation or social or economic status.

    Scholarships are not renewable.

    2

  • PLEASE READ THIS SECTION ON IMPORTANT TIPS BEFORE GOING ANY FURTHER.

    • Usethecorrectapplication–photocopiesareallowed.Donotuseanapplicationfromapreviousyear. • Printneatlyortypeyourapplicationasclearlyaspossible. • Makesuretoincludecity,stateandzipcode.Donotuseabbreviationsinregardstoyourcity. • Supplyanactiveemailorphonenumber,includingareacode,whereyoucanbereachedincaseofquestions. • Putyourfullnameonthetoprighthandcornerofeverypageofeveryiteminthepacket. • Fillinallblanksontheapplication.Ifitdoesnotapplytoyou,useN/A. • Referencesmustbemadeusingthereferenceforms.Additionallettersofreferencewillbeaccepted. • Makesureallrequireditemsareincluded.Ifanypartismissing,thatcouldautomaticallydisqualifyyou. • Makeacopyofyourtotalapplicationpacketforyourrecords. • USE AT LEAST A 9” X 11” ENVELOPE. DO NOT FOLD THE APPLICATION. • DO NOT USE STAPLES. You may use paper clips. • DO NOT PUT THE APPLICATON IN A BINDER OR FOLDER. This will be removed and disposed of before going to the judges. • DO NOT INCLUDE A PHOTOGRAPH WITH YOUR APPLICATION. This will be removed and disposed of before going to

    the judges. • Address to send application:

    Mediacom World Class – The Mediacom Scholarship Program 3737 Westown Parkway Suite A West Des Moines, IA 50266

    How much is the scholarship? • $1,000

    Who is eligible? • Highschoolseniorswhoaregraduatingin2011andliveintheareasservicedbytheNorthCentralDivisionofMediacom

    are eligible.

    How can I be sure if I live in an eligible area? • IfyourcommunityisservicedbytheNorthCentralDivisionofMediacom,youareeligible.Thereisalistofthetownswe

    service in the application. A copy is also available online at www.mediacomworldclass.com.

    The application says to get two references. Who should I ask for this? • Thereferencesshouldcomefromteachers,coaches,sponsors,tutors,counselorsoranyonewhoworkswithyouona

    day-to-day basis and can vouch for you and your abilities. • Ifyouarehomeschooled,anyonewhoworkswithyouinaneducational,community,churchoremploymentcapacitywill

    be accepted as references.

    Do I have to use the reference sheets in the application or will letters of recommendation be okay? • Thereferencesheetsuseanumberingsysteminrankingyouforjudgingpurposes.Itisrequiredtohavethemfilledout

    and sent in with your packet. • Youmayalsoincludelettersofreferenceinadditiontothereferencesheets.

    3

  • Can a photocopy of the application be used? • Yes.Youmayalsoprintoutadditionalcopiesfromthewebsitegivenaboveormakecopiesfromanoriginal.

    Does the copy of the transcript have to be certified? • Ifpossible,butitdoesnothavetobesealedinaseparateenvelope.If,however,yourschoolrequiresasealedenvelope,make

    sure it is included in the packet you send us. DO NOT SEND IT SEPARATELY.

    What are you looking for in the essay? • Theessayshouldnotbealistofyouraccomplishments.Itshouldbeanarrativethatshowshowyouhavelearnedleadership,

    how it has helped you and how you use it to help others. n Avoidmakingitan“I”list,witheverythingstartingwith“Idid…”or“Iwent…” n Be creative. Write something that will grab the judges’ attention.

    Is there anything else I can send that may be helpful to the judges? • Youmayalsoincludealistofachievements,awards,accomplishmentsandschoolclubs.Thiscanbeincludedwiththelistof

    communityeventsandorganizationswithwhichyouareinvolved.Remembertokeepthislistseparatefromyouressay.

    What do you mean by community events and organizations? • Thiswouldincludechurchgroups,civicgroups,volunteerwork,BoyorGirlScouts,SpecialOlympics,etc.Anyorganization

    outside of school with which you are currently or have been involved.

    What is the deadline for the application? • TheapplicationandallothermaterialsmustbepostmarkednolaterthanFebruary11,2011.

    I plan to go to a vocational school. Am I still eligible? • Yes.Anytypeofsecondarytrainingiseligible.

    I will be a sophomore in college next year. Am I eligible? • Onlyifyouearnedyourcollegecreditswhilestillinhighschool.

    Is the scholarship renewable? • No.TheWorldClassMediacomScholarshipisaone-time,non-renewableaward.

    My parent works for Mediacom. Am I eligible? • No.

    When will the scholarships be awarded? • ThescholarshipswillbeannouncedbyApril15,2011.

    If I am awarded a scholarship, what do I have to do to get the money? • Ifyouareselectedforascholarship,thecommitteewillnotifyyoubyletter.Theletterwillcontainfurtherinstructions.

    How will the scholarship money be paid? • Themoneywillbegivendirectlytothestudentstouseastheyneedfortheircollegeexpenses.Thismaybedonebymail,

    orareaMediacomofficesmaychoosetopresentthem.Moreinformationwillbeavailableafterrecipientsarechosen.

    IfyouhaveanyotherquestionsconcerningtheWorldClass–TheMediacomScholarshipProgram,pleasecontactusat [email protected]

    4

  • PLEASE PRINT CLEARLY OR TYPE THE INFORMATION BELOW

    applicationSECTION ONE: PERSONAL INFORMATION

    Applicant’sName_______________________________________________________________________________________

    Address________________________________________________________________________________________________

    City____________________________________________________State______________________Zip_________________

    TelephoneNumber___________________________EmailAddress_______________________________________________

    SECTION TWO: ACADEMIC INFORMATION

    CurrentSchool_________________________________________________________________________________________

    Address_______________________________________________________________________________________________

    City____________________________________________________State______________________Zip_________________

    TelephoneNumber_____________________________________________ClassRank____________outof____________

    AnticipatedGraduationDate(Month/Year)_________________GradePointAverage____________outof____________

    Nameandsignatureofhighschoolguidancecounselor,verifyingtheacademicinformationabove:

    PleasePrint_________________________________Signature________________________________Date_____________

    SECTION THREE: ESSAY

    Aspartofthisapplication,weaskthatyouwriteandattachanoriginalessayof400-500words(typedanddouble

    spaced).Thisessayshoulddescribehowyouexhibitleadershipinyourschoolandcommunity.Aseparatelistof

    honors, awards and accomplishments that you have achieved may be included.

    SECTION FOUR: COMMUNITY INVOLVEMENT

    Pleaselistthecommunityeventsandorganizationsinwhichyouparticipate(attachaseparatesheetifneeded).

    _______________________________________________________________________________________________________

    _______________________________________________________________________________________________________

    SECTION FIVE: REFERENCES

    •Makephotocopiesoftheformsonpages6-7.Giveacopytotwoeducatorsinyourschool.Oncetheseforms

    are completed and returned to you, send them to us with the rest of your application materials.

    •Remembertomakeacopyofallapplicationmaterials(exceptthereferences)foryourself.Thematerialsyou

    senduswillnotbereturnedtoyou.WewillletyouknowduringApril2011,whetherornotyouhavequalified

    for a scholarship.

    SECTION SIX: TO BE READ AND SIGNED BY SCHOLARSHIP CANDIDATE

    Ihearbydeclarethatallinformationcontainedinthisapplicationistruetothebestofmyknowledge.Theessay

    ismyownwork.Ialsoagreetoabidebyallscholarshippoliciesasdetailedinthisdocument.

    Signatureofcandidate____________________________________________________Date_____________________________5

  • communities servedYOU ARE ELIGIBLE TO RECEIVE A SCHOLARSHIP IF YOU LIVE IN A COMMUNITY LISTED BELOW

    ARIZONA AjoAmadoApache JunctionArrivacaGoldCanyonMesaNogalesCityNogalesCountyPinalCountyQueen CreekQueen ValleyRioRicoRockShadowsSandTanksSantanValley

    CALIFORNIA BodfishClearlakeCobbCounty LakeHiddenValleyLakeInyokernIsabellaKelseyvilleKernvilleLakeportLower LakeLucerneNaws“ChinaLake”NiceRidgecrestRiversideCountySanSanBernardinoCountySanPasqualSunCityTronaValley CenterWeldonWoffordUpperLakeValley CenterInyokernRcBodfishKernvilleWeldonWoffordH

    ILLINOISAbingdonAlbanyAledoAlexisAltamontAltonaAltopassAndalusiaAndoverAnnawanApolla AcresAppleRiverArcolaArenzvilleArgyleArthurAshmoreAstoriaAtkinsonAtlantaAtwoodAvonBayles LakeBayviewGardensBellflowerBelvidereTWPBementBensonBloomingtonBodenBracevilleBradfordBrimfieldBruceBudaBuffaloBulpitBureauBurlingtonBushCaledoniaCamargoCambriaCambridgeCandlewick LakeCantrallCapron

    Carbon CliffCarbondaleCarroll CountyCarterville CarthageCaseyCerroGordoChadwickChampaign CountyChapinCharlestonChatsworthChemungChenoaChillicotheClark Clay CityClearlake TrailerClearlake VillageClevelandClintonCoal ValleyCobdenCoffeenColesColes CountyColfaxColonaColpCordovaCornellCortlandCoultervilleCrainvilleCrawfordcrescent CityCullomDakotaDallasCityDanversDavisDavisJunctionDawsonDaytonTwpDeLandDeerCreekDelavanDesotoDowellDownsDownsSubdivisionDunlapDurandDwightEagleEarlvilleEastBrooklynEastDubuqueEastMolineEdinburgEffinghamElPasoElburnEldoradoElizabethElkartElkvilleElmwoodEmdenEnergyErieEssexEurekaFairburyFairmont CityFairviewFarHillsFarinaFarmer CityFarmingtonFayetteFisherForrestFranklin CityFultonFyre LakeGalenaGalenaTerritoriesGalvaGardenPrairieGarrettGeneseoGenevaGermanValleyGermantownGibsonCityGiffordGilberts

    GlasfordGodleyGoodHopeGoodfieldGrantParkGranvilleGreenRockGreenValleyGreenupGreenviewGrundyCountyHamiltonHammondHampshireHamptonHannaCityHanoverHarrisburgHartsburgHarvelHebronHeckerHendersonHennepinHenryHenryCountyHerrickHerrinHeyworthHillsdaleHinckleyHindsboroHopedaleHopewellEstatesHudsonHumboltHurstHutsonvilleIndustryIpavaIroquoisCityIrvingIvesdaleJackson CountyJacksonvilleJeisyvilleJoDaviessJohnson CityKane CountyKangleyKankakee CountyKansasKentland-OutKincaidKirklandLaconLakeSaraLakeSummersetLamplighterLanark Lasalle County Leland Lena LeroyLexingtonLoamiLodaLomaxLondonllsLouisvilleLudlowLyndonMackinawMackinaw Trailer Court Madison CountyMahometMalta Manlius MansfieldMapleParkMaquonMarionMark Marseilles MarshallMartinsvilleMathervilleMattoonMcconnell McHenryCountyMcleanMechanicsburgMelvinMetamora MiddletownMilan Milledgeville

    Mineral MinierMinonkMinookaMobetMoline MomenceMonroe Center Monroe CountyMonticelloMorrisMorrisonMorrisonvilleMoundsMounds CityMt. AuburnMt. Carrol MurphysboroNaplateNauvooNeogaNeponsetNewBerlinNewHollandOakGroveOakParkEstOaklandOblongOconeeOdellOquawkaOrangevilleOrionOsco/HenryCountyOttawaOtterCreekPalestinePalmerPaxtonPearlCityPecatonicaPeoriaCountyPerryCountyPesotumPiersonStationPontiacPontoosucPoplarGrovePortByronPrairieCityPreemptionPrincevilleProphetstownRantoulRapidsCityReadingRedBudReynoldsRichmondRidottRingwoodRiverOaksRoanokeRobinsonRockCityRockIslandRollingMeadowsRosevilleRoyaltonSouthJacksonvilleVillage SaintAugustineSaintClairSaintDavidSaintElmoSanJoseSangamonCitySauneminSavannaSaybrookScalesMoundSecorShabbonaShadyOaksShannonSheffieldSheldonSheridanSherrard/FyrShipmanSigelSilvisSmithtonSmithvilleSolonMillsSomonaukSouthOttawaTwpSouthWilmington

    SparlandSpringBaySpringGroveSpringfieldStandardStandfordStephesonCountyStewardsonStocktonStrasburgStreatorStronghurstSugarGroveSullivanTampico TaylorRidgeTeutopolisThomasboroThomson TildenTimberRidgeToledoTolonoTolucaToulon ToveyTowandaTowerHillTuscolaVarnaVermontVictoria VillaGroveViola Walnut WapellaWarren Warsaw WasburnWashingtonParkWataga Waterman WatsekaWaynesvilleWeldonWenonaWest FrankfurtWestfieldWhiteashWhiteside WilliamsfieldWilliamson CountyWilsonvilleWindsorWinnebagoWinslow WolfeRoadWoodford CountyWoodlandWyomingYates CityZiegler INDIANAAdam LakeAdams CountyAlbionAllen CountyAngolaArgosAuburnBlufftonBourbonBremanBrookButlerChurubuscoColumbia CityCromwellCulverDecaturDeerfieldAptsDekalbCountyDemotteDewartLakeFort WayneFrancesvilleFremondGarrettGoodlandGrabillGrovertownHamiltonHoweHuntertownJasper CountyKendallvilleKentland

    KnoxKoontzLakeKosciuskoKosciusko CountyKoutsLacrosseLagrangeLagrange CountyLake CountyLakevilleLaottoLapazLeesburgLeo/CedarvleLigonierMaldenMarshallMedaryvilleMilfordMonroeNappaneeNewDurhamNobleCountyNorthJudsonNorthLibertyNorthachesterNorthWebsterPiercetonPonetoRomeCityRoselandRosewoodManorSaintJoeSaintJosephSanPierreSchneiderSkinnerLakeSouthWhitelyStarkeCountySteubenCountySyracuseTippeconoeTocsinTri LakesUniondaleVeraCruzWabash CountyWalkertonWanatahWaterlooWells CountyWestvilleWheatfieldWocottville

    IOWA AckleyAdelAgencyAlbiaAlgonaAltaAltoonaAmanaAmesAnamosaAnkenyAplingtonArnoldsParkAsburyAtalissaAtlanticAudubonAvocaBancroftBarnumBeaconBeamanBedfordBellePlaineBelmondBertramBettendorfBloomfieldBlueGrassBondurantBooneBoonevilleBrittBuena VistaBuffaloBuffalo CenterBurlingtonBurtBusseyCalhounCalmarCamanche

    CarlisleCarrollCedar FallsCedarRapidsCentervilleCerroGordoCharitonCharles CityCharlotteCherokeeClarindaClarionClaytonClear LakeClintonClinton CountyCliveColfaxColumbus CityColumbus JunctionConradCoralvilleCorningCorydonCrescoCrestonDakotaCityDallasDallasCenterDanvilleDavenportDecaturCityDecorahDelawareCountyDenisonDenverDesMoinesDesMoinesCountyDesotoDewarDewittDexterDikeDubuqueDubuqueCountyDuncanDurantDyersvilleDysartEagleGroveEarlhamEddyvilleEdgewoodEldonEldoraEldridgeElginElkRunHeightsElkaderElmaEmmetsburgEpworthEssexEsthervilleEvansdaleFairbank Fairfax FairfieldFarley Fayette Forest City Fort AtkinsonFortDodgeFort Madison Fredericksburg Fredonia GarnavilloGarnerGarwinGilbertvilleGilmoreCityGlad-brook GlenwoodGliddenGooseLakeGrangerGreenMountainGreenfieldGrimesGrinnellGrundyCenterGuttenbergHamiltonHamptonHardinCountyHarlanHarper’sFerryHarris

    Questions may be sent to: [email protected]

  • communities servedYOU ARE ELIGIBLE TO RECEIVE A SCHOLARSHIP IF YOU LIVE IN A COMMUNITY LISTED BELOW

    HartfordHazletonHiawathaHillsHudsonHumboldtHuxleyIndependenceIndianolaIowaCityIowaFallsJanesville Johnston Jones County Kalona Kellerton Kensett Keokuk Keota Knoxville Lake City LakeParkLakeside LambsGroveLamoni Lansing Laporte Laurens Le Claire LeGrandLee County Leland Leon LimeSpringsLinn Lisbon Lone Tree LongGroveLovilia Low Moor Lucas Lynnville Madrid Manchester Manly Manson MaquoketaMarengo Marion MarquetteMarshalltown Mason City Maynard McCausland McGregorMelcherMiddletown Miles Mills County Mitchellville Monroe Monticello Montrose MorningSunMount Joy Mt Ayr MtPleasantMt Vernon Mt.PleasantNevadaNewAlbinNewHamptonNewHartfordNewLondonNewSharonNewhallNewtonNorthEnglishNorthLibertyNorthwoodNorwalkNorwayOelweinOkobojiOrleansOsageOsceolaOskaloosaOssianOttumwaOxfordOxfordJunctionPanoramaParkParkViewParkersburgPellaPerryPleasantHill

    PleasantValleyPleasantvillePlymouthPocahontasPolkCityPrairieCityPrestonPrincetonRandallRaymondRedOakRedfieldReinbeckRiverdaleRiversideRockwellRockwellCityRuralClintonCountyRuralJacksonCountySabulaSacCitySagevilleScottSheffieldSheldahlShellRockShenandoahShorewoodAcresShueyvilleSigourneySlaterSolonSpencerSpillvilleSpiritLakeStormLakeStoryCityStrawberryPointStuartSullySumnerSweaCitySwisherTama TiffinTipton ToddvilleToledo Traer UniversityHeightsUniversityParkUrbandaleVan Meter Ventura Villisca Vinton Viola WahpetonWalcott Wapello Washburn Washington Waterloo Waukee Waverly Webster Webster City Wellman West Branch West Burlington WestDesMoinesWest Liberty WestOkobojiWestPointWestUnionWestwood What Cheer Williamsburg WindsorHeightsWinterset Woodburn Woodward Wright Wyoming

    KANSASAltoonaBaldwin CityBurlingameBurlingtonCarbondaleEdgertonEurekaGalenaGridleyHamiltonLeboLeroy

    LyndonMadisonMulberryNewStrawnOsageCityOswegoScrantonThayer TorontoTreeceWellsville

    KENTUCKYAlbanyAlmoBarrenBeeSpringBentonBig CliftyBonnievilleBrekenridge CountyBrownsvilleButler CountyCadizCaldwell CountyCalloway CountyCalvert CityCaneyvilleCasy CountyChristian CountyClintonClinton CountyCrittendenCroftonCumberlandDaviessCountyDoverEdmonsonCityEdmontonElktonFordsvilleFredoniaGamalielGilbertsvilleGraysonCountyGuthrieHardinHartCountyHendersonHerdinCountyHopkinsCountyHpokinsvilleLarue CountyLincoln CountyMadisonvilleMarionMarrowboneMarhsall CountyMelwoodMonroe CountyMorgantownMumfordvilleNeboNortonvilleOakGroveOhioCountyParkCityPembrokePickettCountyPrincetonRockcastleCountyRussellCountySaintPaulSalemSonoraSummershadeSweedenTodd CountyTompkinsvilleTrentonTrigg CountyUptonWhitesville

    MICHIGANAlmena TownshipAntwerp TownshipMarcellus TownshipMattawanMendonMendon TownshipOshtemo MINNESOTAAdams Appleton Arlington Atwater Aurora

    Beaver Bay Belgrade BellePlaineBirdIslandBiwabik BloomfieldBloomingPrairieBoveyBrooten Brownsdale Brownsville Brownton Buffalo Lake Buhl ButterfieldCaledonia Calumet City Cannon Falls CanteburyEstatesCanton Carlton Chanhassen ChatfieldChisholm Chokio Clara City Cleveland ClintonClontarfCloquetCohasset Collinwood Twp Cook Cosmos CreditRiverDakotaDanubeDarwinDassellTownshipDawsonDeephavenDodgeCenterDoverTwpElkoEllsworthEvelethExcelsiorFairfax Fayal FlorenceFranklin Fulda GaylordGibbonGilbertGracevilleGrandMaraisGrandRapidsGrandRapidsTwpGraniteFallsGreenwoodGroveCityHadleyHamburgHancockHarrisTwpHassanValleyHayfieldHectorHendersonHermantownHibbingHokahHoustonHowardLakeHoytLakesHutchinsonIndependenceIvanhoeJanesville Kasota Keewatin Kenyon Kinney Lafayette Lake Benton Lake City Lake City TownshipLake Crystal Lake Jefferson Lake WashingtonLanesboro Laprairie LeSueurLeroy LesterPrairieLitchfieldLong Lake

    Lonsdale Loretto LowerSiouxLuverne Lyle Mabel Madison Mantorville MaplePlainMarbleMaynard Mckinley Medina Midway Twp Minnestria Minnetonka Montgomery Moose Lake Moose Lake Twp Morris Morris Twp Morton Mound MountainIronMountain Lake MountPleasantNashwaukNewMarketNorthRedwoodNorwoodOliviaOronoPaynesvilleTownshipPaynesvillePembertonPetersonPipestonePrestonPriorLakeProctorRedwoodFallRiversideTeRushfordSaintBonifaciusSaintCharlesCitySaintCharlesTwpSaintJamesSaintPeterSavageShorewoodSilverBaySilverLakeSlaytonSleepyEyeSpringGroveSpringLakeSpringParkSpringValleySprintValleyTwpSpringfieldStarbuckStewartSturgeonLakeSunburgSunriseVillTaconiteThomson Tonka Bay Trosky TwoHarborsTyler Veseli Victoria Virginia Waconia Waldorf Waltham Waseca WayzataWebster Wells West ConcordWhite TownshipWheaton Windemere Winnebago Winsted Winthrop Woodland Worthington Young America

    MISSOURIAirportDriveAlbaAlbanyAndersonAppleton City

    ArchieAshGroveAvaBattlefieldBethanyBillingsBoone CountyBrunswickButlerCaboolCallawayCameronCarl JunctionCarrolltonCaruthersvilleCassvilleClay/RayCountyColumbiaCraneCrystal LakesDiamondDuenwegDuquesneEvertonExcelsiorEstatesExcelsiorSpringsExeterForsythForsythRuralGoldenCityGoodmanGranbyGreenCountyGreenfieldHaytiHaytiHeightsHenriettaHermannHoltsSummitHomesteadVillageJasperJasper CountyJefferson CityJoplin Kimberling CityLawsonLiberalLockwoodLowery CityMansfieldMarcelineMarshfieldMillerMt. VernonNeckCityNewtoniaNorborneOronogoOsceloaPurcellPurdyPurdyRuralRichmondRogersvilleSalisburySarcoxieSeymourSpringfieldStarkCityStraffordUniversityofMissouriWalnutGroveWillardWoodHeights

    OHIOAntwerpHicksville

    OKLAHOMACardinPicherQuapaw

    SOUTH DAKOTAArlington Aurora Brookings Bruce Castlewood Colman DesmetEganElktonEstellineFlandreau HaytiLakeNorden

    LakePrestonSDSUVolga White

    TENNESSEEBigRockDoverStewardCounty

    WISCONSINAlbany Argyle Belmont Benton Blanchardville Boscobel City Bridgeport Twp Brookview Browntown CampDouglasCashton Chaseburg Coon Valley Crawford County Cuba City DarlingtonEastDubuqueElkhornEssman&AbleFennimore Ferryville Footville Fort Mccoy Fremont GayMillsGermantownGrantCountyGreenfieldHazelGreenHustlerIolaJuneau County La Farge Lacrosse Lafayette Twp Lagrange Twp MartintownMauston Mcgregor Monticello Muscoda NecedahNewLisbonNorwalkOntarioOrfordvillePotosiPrairieDuChienReadstownRichlandCountyScandanaviaShelbyShullsburgSoldiersGroveSouthWayneStoddardTennyson Vernon CountyViolaViroquaWestby Wilton

    7

  • 8

    referencesREFERENCES FOR THE SCHOLARSHIP CANDIDATE

    Pleaseprinttheinformationbelow:

    Nameofcandidate_________________________________________________________________________________________________________

    Yourname________________________________________________________________________________________________________________

    Yourrelationshiptothecandidate___________________________________________________________________________________________

    Pleaserankthecandidateineachofthecategoriesbelowbycirclingtheappropriatenumberforeachitem.

    ThecandidatemustmailthisandallotherapplicationmaterialsonorbeforeFebruary11,2011.

    RATING SCALE

    Ratethecandidatecomparedtothetypicalstudentinyourschool.

    4-Outstanding3-AboveAverage2-Average1-BelowAverage

    •Leadershipinschool 4 3 2 1

    •Leadershipincommunity 4 3 2 1

    •Characterandintegrity 4 3 2 1

    •Self-reliance 4 3 2 1

    •Initiative 4 3 2 1

    •Creativity 4 3 2 1

    Iherebydeclarethattheaboveinformationisaccuratetothebestofmyknowledgeand/oropinion.

    Signatureofpersoncompletingthisform______________________________________________________Date_________________________

    THANKYOUFORYOURCOOPERATION.

  • 9

    referencesREFERENCES FOR THE SCHOLARSHIP CANDIDATE

    Pleaseprinttheinformationbelow:

    Nameofcandidate_________________________________________________________________________________________________________

    Yourname________________________________________________________________________________________________________________

    Yourrelationshiptothecandidate___________________________________________________________________________________________

    Pleaserankthecandidateineachofthecategoriesbelowbycirclingtheappropriatenumberforeachitem.

    ThecandidatemustmailthisandallotherapplicationmaterialsonorbeforeFebruary11,2011.

    RATING SCALE

    Ratethecandidatecomparedtothetypicalstudentinyourschool.

    4-Outstanding3-AboveAverage2-Average1-BelowAverage

    •Leadershipinschool 4 3 2 1

    •Leadershipincommunity 4 3 2 1

    •Characterandintegrity 4 3 2 1

    •Self-reliance 4 3 2 1

    •Initiative 4 3 2 1

    •Creativity 4 3 2 1

    Iherebydeclarethattheaboveinformationisaccuratetothebestofmyknowledgeand/oropinion.

    Signatureofpersoncompletingthisform______________________________________________________Date_________________________

    THANKYOUFORYOURCOOPERATION.

  • 10

    past scholarship winners2010 WINNERS

    CaliforniaDaniellePappe–InyokernGeorgeCockerton–LakeportKaitlinHeinen–Eldridge

    Iowa JenniferVong–DesMoinesAmelAbdiBare–DesMoinesRyanFrancois–DesMoinesJosephLampe–OsceolaBrentSexton–RockwellCityTaylorAnderson–StormLakeMaryRowley–UrbandaleDhrootiVyas–UrbandaleEmmalineWright–VilliscaJacklynEngelbart–AnamosaAdheshwariRamesh–CedarRapidsLukeDenlinger–DubuqueKristinCanning–LisbonKristenHora–RiversideAndrewRichter–WaterlooShanelWermerskirchen–WaterlooChantalKnepper–Williamsburg

    Illinois JohnPatrickBrown–EastMolineNicoleWenger–FairburyKevinJohnson–RockIslandAmeliaMartens–OrionCourtneyDufford–StocktonKatelynBrozak–StreatorShawnaWagley–HerrinSamuelMartin–CartervilleJohnCross–MoundCity

    Indiana DeborahOhiani-Jegede–Merrillville

    Kansas KaitlinMeyer–LeroyNathaneilJohnson–BurlingameLoganButer–Albany

    Michigan ShaneRussell–Mendon

    Minnesota OliviaBlinn–CloquetMackenzieRein–CookBreannaWalker–GrandRapidsWiphawiSiriphatthanaphinyo–HutchinsonLindsaySummers–JanesvilleBethOchs–Franklin

    Missouri LanaeFlatness–SpringfieldEmilyWhitmarsh–MountVernonMatthewNewman–JasperShelbyNoll–Salisbury

    South Dakota RobertFrancis–BrookingsAnneParsley–Flandreau

    WisconsinOliviaWedig–DarlingtonBrentMecikalski–FremontAlexanderSiemers–LaCrosse

    2009 WINNERS

    IowaEmilyAnderson–AnkenyErikaDavis–SigourneyEthanKilburg–MaquoketaHaleyStreff–UrbandaleJordanHutchens–DesMoinesJordanHarbaugh-Williams–WaterlooKalliHannam–MarshalltownMallorySturtz–NewtonMythiliPrabhu–AmesNathanBleadorn–WaverlyRaeannShimak–MasonCitySarahDooley–BettendorfSethNicholson–DikeShelbySieren–KeotaShelbyEaton–DubuqueSimoneRenault–ClintonToddLyon–ToledoTylerGustafson–SpiritLake

    Illinois ErikaLawson–DavisGabrielleSpeybroeck–EastMolineGrantPierce–StocktonKaseyNelson–OttawaTaraVandygriff–RockIslandShiannPoshard–PontiacMalloryLivezey–CheonaBrittanyBroadwater–DwightCoreySharp–LexingtonKaraJohnson–PaxtonKayleeMcCollum–LouisvilleJodieLatham–OaklandNicholeRush–JacksonvilleMollyStice–JacksonvilleWyattTheodoreGard–MartinsvilleSarahOdle–MarionTaliKasser–Carbondale

    IndianaKassidiVanAllen–KendallvilleMeghanSproch–AngolaIlaA.Jackson–WalkertonJessicaGoldsmith–SyracuseCrystalPearce–NorthJudson

    Kansas AllysonSass–BaldwinCity

    KentuckyErinOakley–CadizJordanHenson–Burkesville

    Minnesota KatelinStrand–BloomingPrairie

    MissouriZacharyBaughman–CarlJunctionClintDeNisco–Mr.VernonBradyChoat–SpringfieldDavidWaites–SpringfieldElizabethDarter–CaboolRobertPowers–ExcelsiorSpringsLoriBeitsch–ColumbiaLindseyBuschjost–JeffersonCityAlexTurner–ColumbiaVirajPatel–Caruthersville

    South Dakota LindsayHieb–Brookings

    Wisconsin HillaryHartley–SoldiersGroveMeganNeitzel–CampDouglas

    2008 WINNERS

    IowaAngelaMarquard–HamptonAnnaStatz–BooneBrianDarling–ToledoChloeDedic–MasonCityDakotaHoben–WapelloEmilyFelkner–CentervilleEthanGingerich–IowaCityIanMitchell–NewHamptinJacquilynErickson–HarlanJaredJohnson–CrestonJasmineChen–AmesJillMcFee–GrinnellJohnBuzynski–HudsonJohnSchulz–CedarRapidsJosephToale–SpencerJustinCullen–StormLakeKalliMartin–DubuqueMeganBalek–NewtonMichelleWallace–JohnsonMickaelStreicher–CedarFallsRobertHumble–EsthervilleSamuelWagner–DavenportSaraWise–DesMoinesShaziaDharssi–CedarRapidsTrevorJohnson–CedarRapids

    Illinois FionaMcGowan–ChillicotheJacobKuban–GeneseoJeffLiles–LenaJoelSedlacko–StreatorMargaretModica–Lena

    Minnesota AmandaImberg–DasselDonaldFahey-Ahrndt–NorwoodYoungAmericaElizabethTroolin–HermantownJonnicaNorell–St.PeterKaylaNygaard–CannonFallsMichaelJordan–Hibbing

    South Dakota BenjaminKantack–BrookingsRachelRemund–Elkton

    Wisconsin AbigailWedig–DarlingtonKelliFischer–Argyle

  • 11

    past scholarship winners2007 WINNERS

    Iowa AlyssaBeatty–CharitonAshleyPetersen–DavenportEdwardOvery,Jr.–ManlyElizabethWalsh–CrestonEmilyRichards–DubuqueFarihaChowdhury–DavenportGabrielParker–Mt.VernonGreenBouzard–WaverlyHayleyNorton–TiptonHeidiWelsh–WilliamsburgJanelleVittetoe–WashingtonJaredGebol–NewHamptonJasonDavis–DavenportJenniferCompton–AmesJohnJessen–DesMoinesJohnKohorst–HarlanJordanKing–DavenportJoshuaStrief–SacCityKariMcCann–CrestonKellyWenman–CoralvilleKristinWilson–LoviliaLindsayStoll–SpiritLakeLisaGudenkauf–CedarRapidsNicoleStoll–CrestonPaulNelson–IowaCityRyanBudding–WiltonShreyaMadhavaram–CedarRapidsStephanieLeinen–DesMoinesTaylorSeemuth–IowaCityTylerMiller–Mt.PleasantVanessaShiu–IowaCityYouranYe–WestDesMoines

    Illinois BrittneyKajdacsi–ColonaEvaHoffrichter–PontiacHeidiIsermann–StreatorLaurenMarshall–FairburyMatthewGonitzke–RockfordMelanieLindell–GenescoShannonFailia–KirklandSkylarKempel–LenaToddEpps–GibsonCity

    Minnesota ChristinaMiles–VictoriaJeffreyBuchwitz–VirginiaJoelleElmer–WellsLauraJensen–NorwoodYoungAmericaLauraNorthrup–WaconiaMiaJohnson–Duluth

    Wisconsin AngelaWalhovd–MaustonBrookeAnderson–IolaKaleeCrist–Darlington

    2006 WINNERS

    IowaAlexanderSalem–WestDesMoinesAmandaEikenberry–DesMoinesAmyXu–FortDodgeAndrewJennett–CrestonBrandonGoodman–BooneBrentMiller–RockwellCityCaitlinHerrnstadt–AmesCaitlinNiggemeyer–MaynardCalliFriesen–IowaFallsCatherineGardner–OttumwaChristinaSchiltz–CliveElizabethStaloch–OttumwaEmilyWarford–DesMoinesHeidiRamaeker–CrestonHungBui–DesMoinesJamesZhang–FortDodgeKarlaFisher–CrestonKathyrnHeiar–ManchesterKatieYourstone–UrbandaleKristinHanson–MasonCityLauraKuennen–NorthwoodMarisaErlandson–SpiritLakeMeganDeahr–HumboldtMeganSkinner–DesMoinesMeredithHobson–UrbandaleMeredithRitter–UrbandaleRobRomero–AltoonaSamanthaToole–DesMoinesSarahCramer–DesMoinesSarahSchlitter–GladbrookSpencerPflum–BurlingtonThomasGrooms–DesMoinesWhitneyCarson–Swisher

    Illinois BriannaMartinez–LenaKatherineCain–EastDubuqueKathrynStaver–Galena

    Minnesota AlissaJansen–StPeterBriannaFrey–HoytLakesBrittanyGentzler–PipestoneJamieKallestad–CloquetJohnWeitgenant–WorthingtonKelseyLoeger–PipestoneLauraEngman–MountainIronLauraValdmanis–PriorLakeLauraKloeckl–Arlington

    South Dakota AllisonStruck–YanktonEmilyTschetter–BrookingsHannahAlsgaard–Yankton

    Wisconsin JosephSteiner–PotosiMartinaLogan–Mauston

    2005 WINNERS

    IowaBenjaminOstrander–FortDodgeBlakeYocom–CharitonMeganSrinivas–FortDodgeBenjaminFranta–ElkaderKimberlyCessna–CedarFallsKathleenHession–IowaCityJessicaTekippe–ManchesterRachaelCox–AmesRyanMichel–ClintonDavidDrustrup–DesMoinesSarahGragg–WaukonHollyDrury–GladbrookAdamDeppe–MaquoketaRyanSnider–CliveJonathanScheller–MasonCityChristinaBunte–FortDodgeChelseaBurkhart–WoodwardNgocHo–DesMoinesNathanRiggle–DesMoinesEvanOlson–NewhallWillettaWaisath–KeokukBrettJones–AnkenyKaylaAllison–EddyvilleSuzanneDroste–WaterlooKathrynLown–PleasantHillSamuelJohnson–Creston

    Illinois LisaWong–StreamwoodMickenzieWade–CartervilleStevenWilliams–SalemTaylorHahn–SalemAnastasiaYanchilina–ArlingtonHeightsJessicaTempleman–GeffAshleyChapman–JohnstonCityJacalynCeglinski–AshleyLaurenMason–Carterville

    Minnesota LeannaMarking–GrandRapidsNicoleJackson–ChanhassenKarmelaSunell–GrandRapidsKevinTroy–EaganStephanieGadow–PriorLakeJeremiahWala–Waseca

    South Dakota HeatherBossert–AberdeenNicholeTaylor–RapidCitySaraHieb–BrandonMeganRieck–WarnerReeceAlmond–HuronRachelFuhrman–CanistotaSaraMcGirr–Huron

    Wisconsin JeremyPingel–CatoTracyHansen–Allenton

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