THE COMMUNITY FOUNDATION OF BURKE COUNTY

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THE COMMUNITY FOUNDATION OF BURKE COUNTY ROBERT A. BOB SHOOK MEMORIAL SCHOLARSHIP DESCRIPTION The Robert A. Bob Shook Memorial Scholarship was established by the Rutherford College Lions Club in 2015 to honor the life of Bob who was an educator, coach and member of the Rutherford College Lions Club for over 30 years. The primary purpose of the fund is to provide financial resources for the higher education of a young person in eastern Burke County. ELIGIBILITY Scholarships will be offered to East Burke High School and/or Jimmy C. Drauhgn High School students. The scholarships will be awarded without regard to race, creed, sex, ethnic background or handicap. The scholarships are available to students who are planning to attend a two or four year college or university. CRITERIA (IN ORDER OF PRIORITY) 1 st Commitment to a two or four year college or university 2 nd Preference given to student pursuing a degree in education 3 rd GPA 3.0 4 th Demonstrates scholastic achievement and academic ability 5 th Demonstrates community involvement, volunteer work and extracurricular activities 6 th Demonstrates a strong work ethic SELECTION PROCESS The recipient s application, including all attachments, must be sent to the Rutherford College Lion s Club by March 31 st. The Rutherford College Lion s Club Scholarship Committee will submit all recommendations to the Community Foundation Scholarship Committee who will review all nominees and make its recommendation to the Board of Directors. The Board of Directors of the Community Foundation of Burke County shall give final approval to the nominee who is awarded the scholarship. If you are a graduating senior, please submit a completed application by March 31 st to: Rutherford College Lion s Club 2035 Lake Acres Drive Hickory, NC 28601-7231

THE COMMUNITY FOUNDATION OF BURKE COUNTY PAYMENT OF AWARDS Payment of scholarship awards will be made directly to the college or university, in accordance with financial policies established by the Board of Directors of the Community Foundation of Burke County.. If you are a graduating senior, please submit a completed application by March 31 st to: Rutherford College Lion s Club 2035 Lake Acres Drive Hickory, NC 28601-7231

THE COMMUNITY FOUNDATION OF BURKE COUNTY ROBERT A. BOB SHOOK MEMORIAL APPLICATION Please read each entire section before completing the application. APPLICANT INFORMATION Name: Last First Middle Goes By Permanent Address: Email: Date of Birth: Telephone: Place of Birth (City/State or Country): High School: School Name School Phone Number Please include a transcript with your application. FAMILY INFORMATION (List first, the parent/guardian you live with most, if you are still living with your parents or a guardian) Parent/Guardian 1: Occupation: Parent/Guardian 2: Occupation: First Name Last Name Work Phone # Employer: First Name Last Name Work Phone # Employer: Household: (check one) Single Parent: Two Parent: Living Independently: Number of People Living In Household: Check if Applicable: ( ) Father Deceased ( ) Mother Deceased ( ) Parents Separated ( ) Parents Divorced Please include a completed copy of FAFSA or W-2 for previous year with your application. Parent Education Levels: Mother a) High School Graduate: Yes No b) Four-year College Graduate: Yes No Father a) High School Graduate: Yes No b) Four-year College Graduate: Yes No List names and ages of brothers & sisters living at home or in college who are dependents of parent (s) or guardian (s): NAME

SCHOOL ACTIVITIES In the space provided below or on a separate page, please list extracurricular activities in which you have participated during the past four years of high school. Include clubs, sports, student government, fine arts, etc. ACTIVITY 9 th 10 th 11 th 12 th OUTSIDE CLASS APPROX. TIME HRS/WK WKS/YR LEADERSHIP POSITIONS, LETTERS EARNED, AWARDS, RECOGNITION, ETC. COMMUNITY & PERSONAL ACTIVITIES In the space provided below or on a separate page, list community, church/synagogue and personal activities in which you have participated during the past four years of high school. Include volunteer work, youth programs, athletic programs, music, dance, scouting, 4-H, or hobbies to which you have devoted time. ACTIVITY 9 th 10 th 11 th 12 th OUTSIDE CLASS APPROX. TIME HRS/WK WKS/YR LEADERSHIP POSITIONS, LETTERS EARNED, AWARDS, RECOGNITION, ETC. WORK EXPERIENCE In the space provided below or on a separate page, please list any work experience (including self-employment) you have had during the past four years. Include summer jobs as well as employment during the school year. Complete this information beginning with your most recent work experience. EMPLOYER Contact Person & Phone Position Dates Employed Hours/Week NAME COLLEGE/UNIVERSITY INFORMATION (FOR THOSE PLANNING TO ATTEND COLLEGE FOR THE FIRST TIME)

What major(s) would you like to pursue? Please complete the following information for your top three college choices. 1. School/City/State: Admission status: Application Pending Enrollment Offered Enrollment Offer Accepted 2. School/City/State: Admission status: Application Pending Enrollment Offered Enrollment Offer Accepted 3. School/City/State: Admission status: Application Pending Enrollment Offered Enrollment Offer Accepted COLLEGE STATEMENT: Attach a brief statement telling us why these institutions are most appealing to you. RECOMMENDATIONS Please make copies of the attached form and submit no more than three (3) recommendations from a teacher or school official, a club or community sponsor/advisor or any non-family member. All recommendations should be on the attached form and returned to the scholarship committee in a sealed envelope with signature across the seal. OTHER AWARDS Please list below or on a separate page the name, amount and status of any grants or scholarships for which you have applied for the coming school year. NAME OF AWARD AMOUNT GRANTED PENDING Please notify the Community Foundation of Burke County office of any grants or scholarships you receive after you submit this application. CERTIFICATION In voluntarily submitting this application, I certify that the information provided is complete and accurate to the best of my knowledge. Falsification of information may result in termination of any scholarship granted. I give my permission to this Scholarship Selection Committee, the Community Foundation of Burke County Scholarship Committee, the Directors of the Community Foundation of Burke County and the Community Foundation of Burke County staff to release information contained in this application for the purposes of determining and publicizing scholarship awards. Applicant s Signature Date Before submitting this application, please make a copy for your records. Insert all attachments inside the application and clearly indicate your name on the top right corner of all attachments. Do not use staples, since applications must be copied. Please mail a completed application to the Robert A. Bob Shook Scholarship Committee by March 31, at the following address: Rutherford College Lions Club 2035 Lake Acres Drive Hickory, NC 28601-7231 For more information, contact: The Community Foundation of Burke County ~ Telephone: (828) 437-7105 ~ E-mail: nwt@cfburkecounty.org

Robert A. Bob Shook Memorial Scholarship Recommendation Form Student s Name: Please note that family members may not be used as references. 1. How long have you known the applicant and in what capacity? 2. In your opinion, will receiving this scholarship make the difference in allowing this student to attend college? 3. Comment on this student s character, academic ability and potential. Signature Date Print or type name Relationship