Scholarships are to be used for financial assistance for full-time students at an accredited university or technical college. Please note that not all scholarships are available each year.

• Don Wehmeyer Memorial Scholarship $1,500.00

• Ellen Halverson Memorial Scholarship $1,500.00

• LaVerne Carter Memorial Scholarship $1,500.00

• Rev. Edward R. Krueger Memorial Scholarship (2nd + year of college/technical college) $1500.00

PERSONAL INFORMATION

Applicant Name (first and last name):

Permanent Address:

City/State/Zip Code:

Phone:

Email:

Date of Birth:

Parent/Guardian Name (first and last name):

Address:

City/State/Zip Code:

Phone:

Email:

WORK EXPERIENCE

Place of Employment (current):

Start date:

Average number of hours worked per week:

Place of Employment:

Start date:

Average number of hours worked per week:

ACADEMIC INFORMATION

o High School Senior

o College Student

School Name (current):

Address:

City/State/Zip Code:

Phone:

Number of years completed:

Graduation Date: GPA (most current):

High School Class Rank: Number in Class:

**A copy of most current transcript must be attached/included.

EDUCATIONAL PLANS

School you plan to attend:

School Address:

City/State/Zip Code:

Phone:

Major(s):

Minor(s):

OTHER INFORMATION:

A resume or separate document may be attached if more space is needed.

List your goals and aspirations:

List your school/extra-curricular activity involvement:

List your community volunteer experiences:

List any special considerations needed (if applicable):

Describe any unusual family or personal circumstances that may have affected your achievement in school, a work experience or participation in school and community activities and detail how you overcame them. Additional notes may be attached separately if needed. (Limit 250 characters)

FOR ASSISTANCE WITH THIS APPLICATION: Contact St. John’s UCC Office (920) 452-5296

NOTES:

Additional information may be requested. This application requires your signature on Page 4. Applications are due back at St. John’s UCC church office on or before May 1st. Scholarships will be awarded June 1st. Applications can be sent via email to: Scholarship.StJohnsUCC@gmail.com

Application Information

1. The applicant must be an “Active Member” of St. John’s UCC in Sheboygan, WI as defined and outlined in Article VI of the St. John’s Bylaws.

2. An applicant must be registered with or have a pending application at an accredited institution of higher education. “Accredited” will be defined as any institution or facility of higher education meeting the minimum requirements of and securing formal academic recognition by the North-Central Association of Colleges and Schools (or its geographical equivalent). Note: Exceptions to this rule will only be made at the discretion of the St. John’s UCC Scholarship Committee (the Committee). A request for a variance(discretionary decision) must be initiated in writing by the application prior to the application deadline. Formal Committee variance discussions will follow any request. A majority vote (at least equivalent to 2/3 of the entire Committee’s members) is needed for any variance to be approved.

3. Ideal candidates will be pursuing a further education in any field, unless the scholarship eligibility requires a particular field of study (e.g., music).The chosen field of education may or may not benefit St. John’s directly, but still promotes the individual to provide goods or services to their communities upon graduation. Except as outlined in this application, each applicant will be given equal consideration, regardless of their chosen field of education/study, which will be based solely on individual character or merit, past achievements, and personal financial needs.

4. Each scholarship is a non-renewable funding source. This means that it must be applied for each year it is made available, and by following the application requirements outlined at the time of application. The individual(s) selected will be chosen after equal and careful consideration of each application submitted and with a majority vote of the members of the Committee.

5. The Applicant must submit the most recent report of their academic achievements, showing their current Grade Point Average (GPA), High School Diploma, or General Education Degree (GED). For reasons of confidentiality, any materials submitted to the Committee will only be used to determine the recipient of each Scholarship.

6. The Committee reserves the right to verify any and all information provided by an applicant on this application form, including any attachments. The Committee may also request additional information to verify accuracy and/or truthfulness, from any related source, if it becomes necessary in assisting the Committee to make a fair and accurate determination for each Scholarship. Therefore, you are providing St. John’s UCC your full authorization to verify and/or secure personal or financial information.

7. Individuals requesting assistance in completing specific portions of the application can receive help by calling the contact listed on page one. If writing to us via the church office, your request will be forwarded to the Committee Chairperson. A Committee member will then contact you to assist in any way possible. Any requests, comments or concerns associated with this application material should be directed to this Committee in a written format, including name, address, and phone number. Appropriate responses will be forwarded to the applicant or author by the Committee after formal committee discussion.

ACKNOWLEDGMENT: I have read and understand the requirements and disclosures above, and I wish to continue the processing of my request for financial assistance, in the form of a scholarship. By signing below, I am authorizing St. John’s UCC and its Scholarship Committee members to secure personal and financial information about me, both now and in the near future. This application authorization will remain in effect for12 months from the date signed below. I fully understand the terms and conditions of this award being offered, acknowledge reviewing this entire application, and I fully accept and understand my personal responsibilities to the Committee, and to St. John’s UCC of Sheboygan, Wisconsin.

Student Scholarship Applicant Signature: (DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application).

Sign:

Date:

Parent/Guardian Signature: (DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application).

Sign:

Date: