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OHIO JCI SENATE CHARITABLE AND EDUCATION FOUNDATION

October 2009Attached is the application for the U.S. JCI Senate Foundation scholarship program. The U.S.JCI Senate is made up of the life members of the U. S. Junior Chamber of Commerce (Jaycees)and fifteen (15) $1,000 scholarships will be awarded this year.This application will also be used for the Ohio JCI Senate Foundation scholarships. This year we will have two (2) categories to choose from. They are:Category 1U.S. JCI Senate criteria (Academic based)Category 2Ohio JCI Senate criteria (Need based)In Category 1 first place will receive $1,000 and second place will receive $500. In addition, firstand second place in Category 1 will be submitted to the U.S. JCI Senate competition.In Category 2 there will be three selected. The first place, which is named the “Morgan JonesMemorial Scholarship”, is awarded $1,000. Second place will receive $750 and third place willreceive $500.,Last year’s winners were: Category 1 -Cody Strahler from Waterford HSZachary L. Dunn from Allen East HSCategory 2 – Nicholas L. Manion from Northeastern HSRebecca Auck from Buckeye CentralKimberly Renner from River View HSPlease note applicants may only submit in one (1) category. Please be sure to mark whichcategory you wish to have your application judged, by indicating your preference at the top of Page 1 of the application.Deadline for submitting applications is January 8, 2010. The state judging will be held bymonth-end. If you have further questions, you can contact me at 740-622-2763 or patrobinson1@roadrunner.com. We in the JCI Senate and also in the Jaycees are very proudof our young leaders of today. They are the future of our country and the leadership of tomorrow.Thank you,

Pat Robinson

Pat RobinsonOhio JCI Senate Chairperson(H) 740-622-2763E-mail –patrobinson1@roadrunner.com

SERVICE TO HUMANITY IS THE BEST WORK OF LIFE

UNITED STATES JCI SENATE FOUNDATIONSCHOLARSHIP PROGRAM

This package contains information and directions for applying to the United States JCI Senate Foundation Scholarship Program. Each year $1,000 grants will be awarded to high school seniors whoare U.S. citizens graduating from U.S. accredited schools, and plan to continue their education at accredited post-secondary colleges, universities or vocational schools. The number of grants awarded annually will be at the discretion of the United States JCI Senate Foundation. They must be used for educational expenses in the first year of full-time study. Checks awarded will be made out in the name of the recipient and the educational institution of their choice.

INSTRUCTIONS FOR APPLYING

Please read the following points carefully. Failure to comply may be cause for disqualification.

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All submissions must be typewritten or printed.

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Included in this application package are all the necessary forms.

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Supporting documentation of your choice may follow each page as appropriate.

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Reference letters are limited to five (5) with a maximum length of one (1) page each.

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Your name must be on the top of each sheet in the package, along with a page numberingsystem that states “page __ of ____”.

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Deadline for submission postmarked is

January 8, 2010

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Mail to :

Pat Robinson

46663 TR 74

Coshocton, OH 43812

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Page 1 of _____

PLEASE SELECT ONLY ONE Category 1Category 2US JCI SenateOhio JCI Senate(

Academic based)(Need based)

UNITED STATES JCI SENATE FOUNDATION

I.SCHOLARSHIP APPLICATION

1.Name of applicant ___________________________________________Date ____________ 2.High school _____________________________________________________________________ 3.Home street address ______________________________________________________________ City _______________________ State ____________ Zip _______ Phone ______________ 4. Student’s e-mail address ___________________________________________________________ 5. United States Citizen (check one) Yes _____ No _____ General Information1.Father’s Name ________________________________________ Check if deceased ___________ 2.Home address ________________________________________ Occupation _________________ 3.Mother’s name ________________________________________ Check if deceased ___________ 4.Home address ________________________________________ Occupation _________________ 5.Do you have a Step-parent or Guardian other than your parents ? __________ 6.If so, what is their name and address ? _______________________________________________ _____________________________________________________________________________ 7. List in chronological order the names of your brothers, sisters or other persons dependentupon your parents for support:Name AgeRelationship __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ College/University you plan to attend:Name _____________________________________________________________ Address ____________________________________________________________ Have you been accepted ? YES ____ NO _____ If yes, attach copy of acceptance letter.

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