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City of Lawrenceburg Educational Grant Program 2011-2012 Application For LHS Seniors Graduating in 2011 The Dearborn Community Foundation, Inc. (DCF) is pleased to administer the City of Lawrenceburg Educational Grant Program. It is the intent of the City of Lawrenceburg to financially assist graduates of Lawrenceburg High School who pursue a post-secondary education and who meet specific eligibility criteria. This grant program began with the Class of 2002. Due to the nature of this program, it is unknown how much each graduate will receive at this time. Educational grants for the 2010-2011 academic year were $1,800 per recipient. Please refer to the guidelines and criteria on the reverse side of this form to determine eligibility. COMPLETED APPLICATIONS MUST BE RECEIVED BY DCF NO LATER THAN 4 P.M. WEDNESDAY, JUNE 1, 2011 Completed application includes signatures on the back of this form. It is the student’s responsibility to verify that the application has been received by the Dearborn Community Foundation (DCF). DCF is not responsible for applications not received. NAME: ____________________________________________________________________________________ ADDRESS:________________________________________________________________________________ CITY:_____________________________________ ZIP CODE:____________________________ SS #:_____________________________________ PHONE:______________________________ EMAIL: _______________________________ YEAR OF HIGH SCHOOL GRADUATION: ________ INTENDED COLLEGE & PROPOSED MAJOR: _______________________/___________________________ This application MUST BE RECEIVED AT THE DCF OFFICE by 4 p.m. June 1, 2011 – NO EXCEPTIONS! (A copy of your high school transcript will be provided from LHS guidance to DCF) By July/August, or when available, if eligible to receive the educational grant, the following post-secondary education information must be provided to the Foundation’s office prior to release of payment: 1. A copy of your official tuition bill which includes the remittance address; 2. A copy of your class schedule; and 3. A “thank you” note sent to the DCF addressed to Lawrenceburg City Council. PLEASE DELIVER TO: Dearborn Community Foundation, Inc. 322 Walnut Street, Lawrenceburg, IN 47025 Phone: 812-539-4115 Email: dcf@comcast.net Page 1 of 2 2011 - 2012 City of Lawrenceburg Educational Grant Guidelines & Criteria for LHS Seniors Graduating in 2011 1. Students must have attended Lawrenceburg High School (LHS) and resided within the Lawrenceburg School Corporation boundaries for at least three (3) full years of his/her high school career; 2. Students must graduate from Lawrenceburg High School; 3. Students must complete a total of 50 approved service learning hours by their graduation date. Service learning hours must be approved by the Foundation; Completed and signed service learning report forms must be on file by 4 p.m. on the Friday prior to LHS’ graduation date of the student’s senior year to be eligible; 4. The grant application must be received at the DCF office by the due date on the application. Students who do not turn in the application by the due date will not be eligible for the educational grant. For years following the initial year, eligible students are required to re-apply for the educational grant and must meet the deadline and criteria for renewal to continue to be eligible to receive educational grant funds. 5. The educational grant is intended to be used during one full year of academic study. Parents and/or students should contact the post-secondary institution for questions relating to how educational funds will be divided between semesters/terms/quarters, etc.; 6. Any graduate wishing to utilize this educational grant must start post-secondary education within one (1) year after graduating from Lawrenceburg High School. Students must contact the Foundation within one (1) year from their graduation date from LHS to remain eligible to receive educational grant funds; i. The only exception would be those students who have enlisted into the United States Armed Forces. Upon receiving an Honorable Discharge, the graduate may then utilize the educational grant program, provided proper paperwork is submitted and approved; 7. The City of Lawrenceburg Educational Grant may be used for up to four (4) consecutive school years of postsecondary education from the date of high school graduation (with the exception as noted in (6)(i) above); 8. All graduates must maintain a cumulative “C” (2.0) grade point average while attending post-secondary school; i. If the graduate does not maintain a cumulative “C” (2.0) average, the educational grant will not be renewed and the student will no longer be eligible to receive educational grant funds; 9. Students must provide the following information prior to the release of educational grant funds directly to the proper educational institution: a copy of the student’s official tuition bill which includes the remittance address; a copy of the student’s class schedule; and a “thank you note” sent to DCF addressed to Lawrenceburg City Council; i. Failure to submit the required materials will result in delayed payment to the educational institution; ii. DCF assumes no responsibility for late payment charges accrued to the student’s account. ACKNOWLEDGEMENT I acknowledge and understand the above-stated guidelines and criteria. By signing below, I agree that I am compliance with the stated criteria and am eligible to apply for this educational grant. I understand that any falsification of information could lead to this educational grant and/or the renewal of this educational grant not being awarded. _____________________________________ Student Signature _________________________________________ Parent/Guardian Signature _____________________________________ Date _________________________________________ Date Page 2 of 2