HIGH SCHOOL SENIOR APPLICATION 

MERRICK FOUNDATION, INC. GENERAL APPLICATION FOR 2003 SCHOLARSHIPS OFFERED TO STUDENTS THAT LIVE IN MERRICK COUNTY OR ATTEND A MERRICK COUNTY SCHOOL

This scholarship program is available to residents of Merrick County school districts.  One scholarship application form covers all scholarships available to high school seniors due in the Foundation office, or postmarked, on February 17, 2003. 

Attached to the General Information form are the requirements for each scholarship. 

Please check all the scholarships you wish to apply for that fit your course of study and your particular community.  To be considered for one of these scholarships, the following regulations must be met:

RETURN ENTIRE FORM WITH SCHOLARSHIPS YOU ARE APPLYING FOR CHECKED. 

1)     A  completed application form with all supporting documents must be filed with the Merrick Foundation, Inc. office postmarked no later than February 17, 2003. 

2)     Submitted with the completed application form must be:

a)  An official transcript of work completed through your first semester senior high

school level. (Must include school verification of your class rank and GPA.)

b)  An essay (no longer than two double-spaced pages) explaining your

educational goals.

c)  A list of extracurricular school and community activities participated in during your high school years. 

3)     Two letters of recommendation are required.  You may turn them in with your application or have your references send them to:  Merrick Foundation, Inc., P O Box 206, Central City NE 68826

a)     Person qualified to furnish a character reference (i.e. involvement in church, community, work or job related, etc.).

b)     Educator who is familiar with your scholastic and leadership abilities as well as your achievements at the high school level.

c)      Pastor recommendation required for Nabity scholarship & two (2) from high school teachers.

d)     Letter from English teacher for Bannister application.

e)     Three letters required for Krug application from teachers, Pastors, or employers.

f)       Letter from a school official for Miller application. 

4)     Financial Need Information Form (optional) - refer to the attached scholarship requirements to determine which scholarships are based on financial need.  They are marked with an *.

Personal Data

Name ____________________________________Social Security #____________________ 

Permanent Address:___________________________________________________________ 

Phone #______________________                     Birth date__________________________

Both parents' names & address(es)(names only if address the same as above):

Father_______________________________________________________________________

Mother_______________________________________________________________________

Educational Background/Program

1)     From what high school will you graduate?_________________________________

2)     School you plan to attend during 2003-2004_______________________________

3)     Address of school_________________________________________________________

Is this a 4-year college?___________

Is this a 2-year vocational/technical college?___________

4)     College/Department enrolled in (i.e. teaching, business, arts & sciences)

________________________

5)     What is your major?_______________________ minor?_________________________

6)     Has your application for enrollment been accepted?________________________

7)     How many credit hours do you plan to carry?______________________________

Work Experience

List your past and present work experience:

          Employer                      Address                Dates              Hours per Week

1)     ___________________  ____________________  _______________  _________________

2)     ___________________  ____________________  _______________  _________________

3)     ___________________  ____________________  _______________  _________________

4)     ___________________  ____________________  _______________  _________________

5)     ___________________  ____________________  _______________  _________________

References: (Please include only two letters unless more are required to meet criteria of scholarships applied for)

List individuals from whom you have requested letters of recommendation:

1.______________________________________Address______________________________

2.______________________________________Address______________________________

SCHOLARSHIP REQUIREMENTS - HIGH SCHOOL SENIORS 

_____  MERRICK FOUNDATION GENERAL SCHOLARSHIPS*

¨      Upper 1/2 of graduating class

¨      Merrick County resident or attending a Merrick County school

¨      Students enrolled in a 4-year course:  two scholarships for students attending Palmer High School, two scholarships for students with Clarks addresses(preference), two scholarships for students attending Nebraska Christian High School, and two scholarships for students with Silver Creek addresses(preference), two scholarships for students with a Western Merrick County address(preference).

¨      Students enrolled in a 2-year course:  one scholarship for a student attending Palmer High School, one scholarship for a student with a Clarks address(preference), one scholarship for a student attending Nebraska Christian high school, one scholarship for a student with a Silver Creek address(preference), and one scholarship for a student with a Western Merrick County address(preference).

¨      Four scholarships for students enrolled in a 4-year course attending Central City High School

¨      Two scholarships for students enrolled in a 2-year course attending Central City High School

¨      Based on (1) Good citizenship in school and community (2) Acceptable scholastic achievement (3) Evidence of perseverance toward goals (4) Financial need

_____  INDUSTRIOUS STUDENT SCHOLARSHIPS*

¨      2.0 - 3.5 GPA or C to B+ average

¨      Any form of continuing education

¨      Two letters of recommendation

¨      Paragraph stating why you are continuing your education, why this scholarship will benefit you, and why you have a financial need

¨      Resident of Merrick County

______ KAREN & DANNIELLE BANNISTER MEMORIAL SCHOLARSHIP

¨      Graduating senior at Aurora, Central City, or High Plains Community  high schools.

¨      Pursuing English major or minor - 4 year degree

¨      Letter of recommendation from English teacher

¨      GPA average or above

______ CHARLES BENNER MEMORIAL SCHOLARSHIP

¨      Central City high school senior with GPA of average or above

¨      Must have participated in FFA during high school

¨      Two letters of recommendation

______ ERVIN & BONNIE BLAUHORN SCHOLARSHIPS*

¨      Three are given annually to high school seniors in Central City or Palmer with at least one going to a Palmer senior

¨      Upper 1/4 of graduating class

¨      Based on character, personality, general health, and financial need

¨      Applicant must be enrolled in a 4-year course

______ CENTRAL CITY CARE CENTER SCHOLARSHIP

¨      Resident of Merrick County

¨      Senior at Central City, High Plains, or Nebraska Christian High Schools

¨      Pursuing a career in the medical profession 

______ MYRTLE AND JIM CLARKE SCHOLARSHIP*

¨      Based on academic grades or overall achievement outside school

¨      Otherwise lack the resources, including student loans, to continue education beyond high school

¨      Attending Central City or Nebraska Christian High schools

     OR

¨      Resident of Clarks, Fullerton, Hordville, Polk, or lake areas south Central City

______ MARSHALL SUCK-COLLINS MEMORIAL SCHOLARSHIP

¨      Palmer High School senior

¨      Upper 1/2 of class

¨      Active in music program at Palmer High School

¨      4 year course of study (first two may be in Community College)

______ LES JOHNSON MEMORIAL SCHOLARSHIP

¨      Senior at Silver Creek/Silver Creek Consolidated high school

¨      Two letters of recommendation from high school teachers

¨      One-page essay stating personal, educational, & career goals

¨      Upper one-half of graduating class

¨ Preference will go to applicant who: (A) Intends to participate in intramural or intercollegiate athletics (B) Intends to seek degree in wildlife mgmt, forestry, or ag.

______ ALICE KLINGENBERG MEMORIAL SCHOLARSHIP

¨      Chapman addressed student

¨      Enrolled in 4 year course of study

______ BONNIE KOHL MEMORIAL SCHOLARSHIP

¨      Resident of Merrick County

¨      High School senior with a 3.5 GPA or higher and enrolling in Bachelor of Science in Nursing program, endorsements from one school official, one teacher, and any one of the following: minister, priest, scout leader, employer, coach, or other youth leader who has a personal knowledge of the applicant

¨      May be continued at the Board's discretion if applicant is continuing study for Nurses degree and maintains 3.0 GPA.

______ ROBERT & LILLIAN KRUG MEMORIAL SCHOLARSHIP

¨      High School senior with Merrick County address

¨      GPA average or above

¨      Active in Merrick County 4-H program for at least 4 years and/or an active member of a Merrick County FFA Chapter for at least 2 years

¨      Three letters of recommendation from teachers, pastors, or employers.

¨      Essay on how 4-H and/or FFA has benefited you to prepare for your future and why you are furthering your education.

______ CHARLES & ANN KUHLMAN MEMORIAL SCHOLARSHIP

¨      Resident of Chapman, Clarks, or Central City area and have attended a local high school

¨      Upper 1/3 of high school graduating class.

¨      Enrolled in 2 or 4 year course of study in agriculture or medical

¨      Essay required on professional goals and steps to achieve them

¨      Exhibit participation in his/her church and community

_____ VERNIE L. LOCK SCHOLARSHIP

¨      Resident of Merrick County

¨      Beauty or Barber school

_____ WARREN MARSH MEMORIAL SCHOLARSHIP*

¨      Resident of Merrick County

¨      Upper 1/4 of class

¨      Financial need

¨      First preference given to students in medical schools

¨      Second preference to other health-related disciplines

¨      If none available for first two preferences, given to other worthy candidates

_____  RAY & MILDRED MILLER MEMORIAL SCHOLARSHIP

¨      Archer vicinity resident

¨      Two hand-written paragraphs describing what you have done to enhance the community, including school leadership roles, and why you have chosen your course of study.

¨      Letter of recommendation from a school official on general leadership and moral character.

_____  ERNEST & PEGGY NABITY MEMORIAL SCHOLARSHIP

¨      Senior at Central City or Palmer

¨      90% or above GPA

¨      Letter from Pastor verifying regular church attendance

¨      Two years of vocal music and/or band in high school

¨      Two letters of recommendation from any high school teachers

¨      Honesty, cooperation, good study habits, respect for others, and responsibility

_____  DORIS E. NEEL MEMORIAL SCHOLARSHIP*

¨      Clarks, NE addressed student

¨      GPA of average or above

¨      A typed, single-spaced, 1 page letter stating career goals, why you are deserving of the scholarship, how you have demonstrated responsibility, maturity of judgment, high integrity and dependability.

¨      Enrolled in accredited college for 2 or 4 year term

¨      Paid in two semesters (second semester paid after receipt of transcript verifying 2.5 or above GPA from first semester)

¨      First choice to LPN or RN student

¨      Financial need

_____  RALPH STANLEY AND ELLA HALSTEAD SEVERANCE MEMORIAL*

¨      Resident of Merrick County

¨      Traditional or Nontraditional student

¨      Financial need

¨      Two letters of recommendation from other than relatives

¨      Cover letter stating why you are continuing your education, why this scholarship will benefit you and why you have a financial need

¨      Renewable if student maintains minimum GPA required for graduation (transcript required) 

_____  WILLIAM AND EMMA STEFFEN NURSES SCHOLARSHIPS*

¨      Seniors at Merrick County high school

¨      Preference given to Nebraska accredited school of nursing students

¨      At least 12 credit hours per semester

¨      Above average GPA

¨      Leadership, social behavior, performance and financial need

¨      Paid by semester upon receipt of transcript verifying satisfactory performance

_____  DYLAN VAN PELT MEMORIAL SCHOLARSHIP

¨      Merrick County or Aurora, Nebraska address

¨      Persevered to overcome a disability

¨      300 word essay about disability and how you demonstrated perseverance, high character, and high effort to overcome it, why you would be a deserving recipient, what your major will be, and why you chose it

_____  AUSTIN & CLEO VANDERFORD SCHOLARSHIP*

¨      Senior at any high school in Merrick County

¨      Based on student's ability, work habits, GPA, and financial need

_____  CLINTON M. WEGNER SCHOLARSHIPS*

¨      Palmer High School senior

¨      Renewable upon receipt of transcript showing 2.5 GPA maintained and class schedule for next semester

¨      Upper 1/2 of graduating class

¨      Demonstrate financial need (Complete financial form each year)

______  EDNA I. WIDMAN MEMORIAL SCHOLARSHIP*

¨      Senior at Central City High School

¨      Enrolled in a college or technical school

¨      Financial need

_____  LEANNE ZMEK MEMORIAL SCHOLARSHIP*

¨      Hair stylist enrolled in beauty or barber school

¨      Senior at Merrick County high school

¨      Financial need

¨      Available only if income is not awarded to girls softball teams in Clarks, Archer, Chapman, and Central City areas

LIST OF SCHOLARSHIPS BY COMMUNITY FOR HIGH SCHOOL SENIORS

ARCHER VICINITY

¨       RAY & MILDRED MILLER MEMORIAL 

AURORA

¨       KAREN & DANNIELLE BANNISTER MEMORIAL

¨       DYLAN VAN PELT MEMORIAL (IN ADDITION TO MERRICK COUNTY ADDRESS) 

CENTRAL CITY

¨       KAREN & DANNIELLE BANNISTER MEMORIAL

¨       CHARLES BENNER MEMORIAL

¨       ERVIN & BONNIE BLAUHORN

¨       CENTRAL CITY CARE CENTER

¨       MYRTLE AND JIM CLARKE

¨       CHARLES & ANN KUHLMAN MEMORIAL

¨       ERNEST & PEGGY NABITY MEMORIAL

¨       EDNA I. WIDMAN MEMORIAL           

CHAPMAN

¨       ALICE KLINGENBERG MEMORIAL

¨       CHARLES & ANN KUHLMAN MEMORIAL 

CLARKS/CLARKS CONSOLIDATED

¨       MYRTLE AND JIM CLARKE

¨       CHARLES & ANN KUHLMAN MEMORIAL

¨       DORIS E. NEEL MEMORIAL 

HIGH PLAINS COMMUNITY

¨       KAREN & DANNIELLE BANNISTER MEMORIAL

¨       CENTRAL CITY CARE CENTER 

NEBRASKA CHRISTIAN

¨       CENTRAL CITY CARE CENTER

¨       MYRTLE AND JIM CLARKE            

PALMER

¨       ERVIN & BONNIE BLAUHORN

¨       MARSHALL SUCK-COLLINS MEMORIAL

¨       ERNEST & PEGGY NABITY MEMORIAL

¨       CLINTON M. WEGNER 

SILVER CREEK

¨       LES JOHNSON MEMORIAL 

RESIDENT OF FULLERTON, HORDVILLE, POLK, OR LAKE AREAS SOUTH OF CENTRAL CITY

¨        MYRTLE AND JIM CLARKE

ALL OTHERS ARE FOR MERRICK COUNTY RESIDENTS OR STUDENTS ATTENDING MERRICK COUNTY HIGH SCHOOLS

FINANCIAL NEED INFORMATION FORM (OPTIONAL)
Please complete in full

        The Merrick Foundation scholarships that are based on financial need are marked with an (*) on the requirements pages.  If financial need information is not provided, you will not be considered for scholarships based on financial need. 

Name: ____________________________________________________________________ 

Permanent address:_________________________________________________________ 

1.   List all scholarships and amounts you have received to date for 2003-2004 school year: ________________________________________________________________________

     ________________________________________________________________________

2.   List Financial Aid packages you have received: _________________________________________________________________________

    __________________________________________________________________________

3.   Will it be necessary for you to be gainfully employed while in school?____________  If so, estimate hours per week that it will be necessary for you to work:___________________

4.   Please list anticipated sources of:

INCOME                                         COSTS 

Savings_______________________________  Tuition____________________________

Earnings______________________________  Fees______________________________

Student Loans_________________________ Books_____________________________

Work grants___________________________ Room/Board______________________

Parental Help__________________________ Personal Expenses________________

Other_________________________________ Other_____________________________

_______________________________________ ___________________________________ 

1.  Father's occupation_________________________

     Mother's occupation________________________

2.  List name and age of each dependent in your family (Line 6c of

     parent's 2002 Form 1040):

        Name ____________________Age____ Name _____________________Age____

        Name ____________________Age____ Name _____________________Age____

        Name ____________________Age____ Name _____________________Age____

3.  Number of dependents in family who will be attending college full-time

     2003-2004. ______

4.  Were you claimed as a dependent on your parent(s)/guardian(s) federal

      income tax in:

      2000: Yes___ No___     2001: Yes___ No___       2002:  Yes___ No___

5.  Please complete the following:

                  Parent's Adj           Number of           Student's Adj      Number of
                 Gross Income          Dependents          Gross Income    Dependents

     2000_____________________  ____________  ____________________  __________

    2001_____________________  ____________  ____________________  __________

    2002_____________________  ____________  ____________________  __________

6.  Do you expect your 2003 income to change significantly from amounts

      shown above?______ If so, for what reason?____________________________

      ______________________________________________________________________

To the best of my knowledge, the above information furnished above is true. 

____________________________________                 _______________________
Student Signature (Required)                                        Date 

____________________________________                 _______________________
Parent or Guardian Signature                                         Date