scholarship

Just like most Midwestern families, the Mediacom family believes in the importance of higher education. As a corporation with strong community roots, we wanted to support, in some way, the higher education of our customers.

For this reason, we formed World Class – The Mediacom Scholarship Program to help graduating high school students with their college expenses, such as tuition and books.

Through the World Class program, Mediacom awards $1,000 scholarships to winning applicants.

Scholarship Application ChecklistBefore you send in your application materials, please make sure you have included the following:

o Completed application with your signature and the signature of your school guidance counselor.

o A copy of your high school transcript.

o Your essay of about 500 words, typed and double spaced.

o The references of two educators from your school, using pages 8 and 9 of this application.

Retain a copy of the above documents for your records. Incomplete packets will be rejected automatically.

To be considered for a World Class scholarship, an eligible student must:

1. Complete and include the application.2. Compose and include the requested essay.3. Include a copy of his or her high school transcript.4. Include references of two educators from his or her school.5. Mail all application materials postmarked on or before

February 15, 2012.

The selection of scholarship recipients is based on:

Academic Achievement: demonstrated by high school grade point average information (GPA) and class ranking.

Leadership: based on self-reliance, initiative and creative ability in school and out, as reflected in the applicant’s personal essay. Additional determining factors include:

• Participation in school activities.• Honors received.• References of two educators from your school.• Participation in community activities.

Completed application materials should be postmarked on or before February 15, 2012, and sent to:

Mediacom World Class – The Mediacom Scholarship Program3737 Westown Parkway, Suite 2AWest Des Moines, IA 50266

Questions may be sent to: scholarship@mediacomcc.com.

A PDF file of the application can be downloaded at www.mediacomworldclass.com.

Eligibility requirements:

Children of directors, officers, employees or agents of Mediacom are not eligible.

Applicants must be legal residents of a community that is being served by the North Central Division of Mediacom (see list on pages 6-7).

Scholarship awardees may attend any accredited two-yearor four-year college, university, technical or vocational school within the United States.

Applicants must intend to pursue a course of study at a qualified post-secondary institution.

Applicants must be accepted by the qualified post-secondary institution prior to actually receiving a scholarship.

Applicants must commence their post-secondary education or training in the first academic year following their senior year of high school.

Applicants must be in their senior year of high school, must be high school graduates or persons who have achieved equivalent certification. If an applicant is awarded a scholarship while in his or her senior year of high school and does not graduate at the end of his or her senior year, he or she is no longer eligible to receive a scholarship.

Students completing high school in less than the normal four years are eligible to apply.

Students entering a qualified post-secondary institution in the middle of their senior high school year are permitted to apply the following year.

All scholarships will be awarded without regard to race, religion, national origin, sexual orientation, political affiliation or social or economic status.

Scholarships are not renewable.

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PLEASE READ THIS SECTION ON IMPORTANT TIPS BEFORE GOING ANY FURTHER.

• Usethecorrectapplication–photocopiesareallowed.Donotuseanapplicationfromapreviousyear. • Printneatlyortypeyourapplicationasclearlyaspossible. • Makesuretoincludecity,stateandzipcode.Donotuseabbreviationsinregardtoyourcity. • Supplyanactiveemailaddressorphonenumber,includingareacode,whereyoucanbereachedincaseofquestions. • Putyourfullnameonthetoprighthandcornerofeverypageofeveryiteminthepacket. • Fillinallblanksontheapplication.Ifitdoesnotapplytoyou,useN/A. • Referencesmustbemadeusingthereferenceforms.Additionallettersofreferencewillbeaccepted. • Makesureallrequireditemsareincluded.Ifanypartismissing,youmaybedisqualified. • Makeacopyofyourcompletedapplicationpacketforyourrecords. • USE AT LEAST A 9” X 11” ENVELOPE. DO NOT FOLD THE APPLICATION. • DO NOT USE STAPLES. You may use paper clips. • DO NOT PUT THE APPLICATION IN A BINDER OR FOLDER. This will be removed and disposed of before going to the judges. • DO NOT INCLUDE A PHOTOGRAPH WITH YOUR APPLICATION. This will be removed and disposed of before going to

the judges. • Address to send application:

Mediacom World Class – The Mediacom Scholarship Program 3737 Westown Parkway, Suite 2A West Des Moines, IA 50266

How much is the scholarship? • $1,000

Who is eligible? • Highschoolseniorswhoaregraduatingin2012andliveintheareasservedbytheNorthCentralDivisionofMediacom

are eligible.

How can I be sure if I live in an eligible area? • IfyourcommunityisservedbytheNorthCentralDivisionofMediacom,youareeligible.Thereisalistofthetownswe

serve in the application. A copy is also available online at www.mediacomworldclass.com.

The application says to get two references. Whom should I ask for these? • Thereferencesshouldcomefromteachers,coaches,sponsors,tutors,counselorsoranyonewhoworkswithyouona

day-to-day basis and can vouch for you and your abilities. • Ifyouarehomeschooled,anyonewhoworkswithyouinaneducational,community,churchoremploymentcapacitywill

be accepted as a reference.

Do I have to use the reference sheets in the application or will letters of recommendation be okay? • Thereferencesheetsuseanumberingsystemforjudgingpurposes.Itisrequiredtohavethemfilledoutandsentin

with your packet. • Youmayalsoincludelettersofreferenceinadditiontothereferencesheets.

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Can a photocopy of the application be used? • Yes.Youmayalsoprintoutadditionalcopiesfromwww.mediacomworldclass.comormakecopiesfromtheoriginal.

Does the copy of the transcript have to be certified? • Ifpossible,yes,butitdoesnothavetobesealedinaseparateenvelope.If,however,yourschoolrequiresasealedenvelope,

make sure it is included in the packet you send us. DO NOT SEND IT SEPARATELY.

What are you looking for in the essay? • Theessayshouldnotbealistofyouraccomplishments.Itshouldbeanarrativethatshowshowyouhavelearnedleadership,

how it has helped you and how you use it to help others. n Avoidmakingitan“I”list,witheverythingstartingwith“Idid…”or“Iwent…” n Be creative. Write something that will grab the judges’ attention.

Is there anything else I can send that may be helpful to the judges? • Youmayalsoincludealistofachievements,awards,accomplishmentsandschoolclubstowhichyoubelong.Thiscanbe

includedwiththelistofcommunityeventsandorganizationswithwhichyouareinvolved.Remembertokeepthislistseparatefrom your essay.

What do you mean by community events and organizations? • Thiswouldincludechurchgroups,civicgroups,volunteerwork,BoyorGirlScouts,SpecialOlympics,etc.Anyorganization

outside of school with which you are currently or have been involved.

What is the deadline for the application? • TheapplicationandallothermaterialsmustbepostmarkednolaterthanFebruary15,2012.

I plan to go to a vocational school. Am I still eligible? • Yes.Anytypeofsecondarytrainingiseligible.

I will be a sophomore in college next year. Am I eligible? • Onlyifyouearnedyourcollegecreditswhilestillinhighschool.

Is the scholarship renewable? • No.TheWorldClassMediacomscholarshipisaone-time,non-renewableaward.

My parent works for Mediacom. Am I eligible? • No.

When will the scholarships be awarded? • ThescholarshipswillbeannouncedinApril2012.

If I am awarded a scholarship, what do I have to do to get the money? • Ifyouareselectedforascholarship,thecommitteewillnotifyyoubyletter.Theletterwillcontainfurtherinstructions.

How will the scholarship money be paid? • Themoneywillbegivendirectlytothestudentstouseastheyneedfortheircollegeexpenses.Thismaybedonebymail,

orareaMediacomofficesmaychoosetopresentthem.Moreinformationwillbeavailableafterrecipientsarechosen.

IfyouhaveanyotherquestionsconcerningWorldClass–TheMediacomScholarshipProgram,pleasecontactusat scholarship@mediacomcc.com.

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PLEASE PRINT CLEARLY OR TYPE THE INFORMATION BELOW

applicationSECTION ONE: PERSONAL INFORMATION

Applicant’sName_______________________________________________________________________________________

Address________________________________________________________________________________________________

City____________________________________________________State______________________Zip_________________

TelephoneNumber___________________________EmailAddress_______________________________________________

SECTION TWO: ACADEMIC INFORMATION

CurrentSchool_________________________________________________________________________________________

Address_______________________________________________________________________________________________

City____________________________________________________State______________________Zip_________________

TelephoneNumber_____________________________________________ClassRank____________outof____________

AnticipatedGraduationDate(Month/Year)_________________GradePointAverage____________outof____________

Nameandsignatureofhighschoolguidancecounselorverifyingtheacademicinformationabove:

PleasePrint_________________________________Signature________________________________Date_____________

SECTION THREE: ESSAY

Aspartofthisapplication,weaskthatyouwriteandattachanoriginalessayof400-500words(typedanddouble

spaced).Thisessayshoulddescribehowyouexhibitleadershipinyourschoolandcommunity.Aseparatelistof

honors, awards and accomplishments that you have achieved may be included.

SECTION FOUR: COMMUNITY INVOLVEMENT

Pleaselistthecommunityeventsandorganizationsinwhichyouparticipate(attachaseparatesheetifneeded).

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

SECTION FIVE: REFERENCES

•Makephotocopiesoftheformsonpages8and9.Giveacopytotwoeducatorsinyourschool.Oncetheseforms

are completed and returned to you, send them with the rest of your application materials.

•Remembertomakeacopyofallapplicationmaterialsforyourself.Thematerialsyousend will not be returned

toyou.WewillletyouknowinApril2012whetherornotyouhavequalifiedforascholarship.

SECTION SIX: TO BE READ AND SIGNED BY SCHOLARSHIP CANDIDATE

Ihearbydeclarethatallinformationcontainedinthisapplicationistruetothebestofmyknowledge.

Theessayismyownwork.Ialsoagreetoabidebyallscholarshippoliciesasdetailedinthisdocument.

SignatureofCandidate____________________________________________________Date_____________________________

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communities servedYOU ARE ELIGIBLE TO RECEIVE A SCHOLARSHIP IF YOU LIVE IN A COMMUNITY LISTED BELOW

ARIZONAAjoApache Jct.GoldCanyonNogalesCitySantaCruzCo.Pinal Co.Queen CreekQueen ValleyRioRicoSantan Valley

CALIFORNIABentonBodfishClearlakeClearlakeOaksClearlake ParkCobbCounty LakeFinleyGlenhavenHiddenValleyLakeInyokernIsabellaKelseyvilleKern Co.KernvilleLakeportLower LakeLucerneMenifeeMiddletownNaws“ChinaLake”NavalBaseNicePauma ValleyRidgecrestSan Bernardino Co.SanPasqualSun CityUpperLakeValley CenterWeldonWildomarWinchesterWoffordHeights

ILLINOISAbingdonAlbanyAledoAlexisAltamontAltonaAltopassAndalusiaAndoverAnnawanApolla Acres AppleRiverArcola ArenzvilleArgyleArthur AshmoreAstoria AtkinsonAtlanta Atwood Avon Bayles LakeBayviewGardensBellflower Belvidere Twp.Bement BensonBloomingtonBodenBracevilleBradfordBrimfieldBruceBudaBuffalo Bulpit BureauBurlingtonBushCaledoniaCamargo CambriaCambridgeCandlewick LakeCantrall CapronCarbon Cliff

CarbondaleCarroll Co.CartervilleCarthageCaseyCerroGordoChadwickChampaign Co.Chapin CharlestonChatsworthChemungChenoaChillicotheClarkClay CityClearlake TrailerClearlake VillageClevelandClintonCoal ValleyCobdenCoffeen ColesColes Co.Colfax ColonaColpCordovaCornell CortlandCoultervilleCrainvilleCrawfordCrescent CityCullom DakotaDallasCityDanversDavisDavisJct.DawsonDaytonTwp.DeLandDeerCreekDelavanDesotoDowellDownsDownsSubdiv.DunlapDurandDwightEagleEarlvilleEastBrooklynEastDubuqueEastMolineEdinburgEffinghamElPasoElburnEldoradoElizabethElkhartElkvilleElmwoodEmdenEnergyErieEssexEurekaFairburyFairmont CityFairview FarHillsFarinaFarmer CityFarmingtonFayetteFisherForrestFranklin Co.FultonFyre LakeGalenaGalenaTerritoriesGalvaGardenPrairieGarrettGeneseoGenevaGermanValleyGermantownGibsonCityGiffordGilberts

GlasfordGodleyGoodHopeGoodfieldGrantParkGranvilleGreenRockGreenValleyGreenupGreenviewGrundyCo.HamiltonHammondHampshireHamptonHannaCityHanoverHarrisburgHartsburgHarvelHebronHeckerHendersonHennepinHenryHenryCo.HerrickHerrinHeyworthHillsdaleHinckleyHindsboroHopedaleHopewellEstatesHudsonHumboltHurstHutsonvilleIndustryIpavaIroquoisCo.IrvingIvesdaleJackson Co.Jacksonville JerseyvilleJoDaviessJohnson CityKane Co.KangleyKankakee Co.KansasKentland-OutKincaid KirklandLaconLake SaraLake SummersetLamplighter LanarkLasalle Co.LelandLenaLeroyLexington Loami LodaLomax London MillsLouisvilleLudlowLyndonMackinaw Mackinaw Trlr. Ct. Madison Co.MahometMaltaManliusMansfieldMaple ParkMaquonMarionMarkMarseillesMarshallMartinsvilleMathervilleMattoonMcConnellMcHenryCo.McLeanMechanicsburg Melvin MetamoraMiddletown MilanMilledgeville

MineralMinier MinonkMinookaMobetMolineMomenceMonroe CenterMonroe Co.Monticello MorrisMorrisonMorrisonville MoundsMounds CityMt Auburn Mt CarrolMurphysboroNaplateNauvooNeogaNeponsetNewBerlinNewHollandOakGroveOakParkEstatesOaklandOblongOconeeOdellOquawkaOrangevilleOrionOsco/HenryCo.OttawaOtterCreekPalestinePalmer PaxtonPearl CityPecatonicaPeoria Co.Perry Co.Pesotum Pierson Station PontiacPontoosuc PoplarGrovePort ByronPrairie CityPreemptionPrincevilleProphetstownRantoulRapidsCityReadingRedBudReynoldsRichmondRidottRingwoodRiverOaksRoanokeRobinsonRockCityRockIslandRollingMeadowsRosevilleRoyaltonS. Jacksonville VillageSaint AugustineSaint ClairSaintDavidSaintElmoSan Jose Sangamon City Saunemin SavannaSaybrook Scales MoundSecorShabbonaShadyOaksShannonSheffieldSheldonSheridanSherrard/FyrShipmanSigelSilvisSmithtonSmithville Solon MillsSomonaukSouthOttawaTwp.South Wilmington

SparlandSpring BaySpringGroveSpringfieldStandardStanford Stephenson Co.StewardsonStocktonStrasburgStreatorStronghurst SugarGroveSullivanTampicoTaylorRidgeTeutopolisThomasboroThomsonTildenTimberRidgeToledoTolono TolucaToulonTovey Towanda TowerHillTuscola Varna Vermont VictoriaVillaGroveViolaWalnutWapella WarrenWarsawWashburnWashington ParkWatagaWatermanWatsekaWaynesville Weldon WenonaWest FrankfortWestfieldWhiteashWhitesideWilliamsfieldWilliamson Co.WilsonvilleWindsorWinnebagoWinslowWolfeRoadWoodford Co.WoodlandWyomingYates CityZiegler

INDIANAAdam LakeAdams Co.AlbionAllen Co.AngolaArgosAuburnBlufftonBourbonBremanBrookButlerChurubuscoColumbia CityCromwellCulverDecaturDeerfieldApts.DekalbCo.DemotteDewartLakeFort WayneFrancesvilleFremontGarrettGoodlandGrabillGrovertownHamiltonHoweHuntertownJasper Co.Kendallville

KentlandKnoxKoontzLakeKosciuskoKosciusko Co.KoutsLacrosseLagrangeLagrange Co.Lake Co.LakevilleLaottoLapazLeesburgLeo/CedarvleLigonierMaldenMarshallMedaryvilleMilfordMonroeNorthJudsonNappaneeNewDurhamNobleCo.NorthJudsonNorthLibertyNorthManchesterNorthWebsterPiercetonPonetoRomeCityRoselandRosewoodManorSaint JoeSaint JosephSan PierreSchneiderSkinner LakeSouth WhitelyStarke Co.Steuben Co.SyracuseTippeconoeTocsinTri LakesUniondaleVeraCruzWabash Co.WalkertonWanatahWaterlooWells Co.WestvilleWheatfieldWocottville

IOWAAckleyAdelAgencyAlbiaAlgonaAltaAltoonaAmanaAmesAnamosaAnkenyAplingtonArnolds ParkAsburyAtalissaAtlanticAudubonAvocaBancroftBarnumBeaconBeamanBedfordBelle PlaineBelmondBertramBettendorfBloomfieldBlueGrassBondurantBooneBoonevilleBrittBuena VistaBuffaloBuffalo CenterBurlingtonBurtBussey

CalhounCalmarCamancheCarlisleCarrollCedar FallsCedarRapidsCentervilleCerroGordoCharitonCharles CityCharlotteCherokeeClarindaClarionClaytonClear LakeClintonClinton Co.CliveColfaxColumbus CityColumbus Jct.ConradCoralvilleCorningCorydonCrescoCrestonDakotaCityDallasDallasCenterDanvilleDavenportDecaturCityDecorahDelawareCo.DenisonDenverDesMoinesDesMoinesCo.DesotoDewarDewittDexterDickinsonCo.DikeDubuqueDubuqueCo.DuncanDurantDyersvilleDysartEagleGroveEarlhamEddyvilleEdgewoodEldonEldoraEldridgeElginElkRunHeightsElkaderElmaEmmetsburgEpworthEssexEsthervilleEvansdaleFairbankFairfaxFairfieldFarleyFayetteForest CityFort AtkinsonFortDodgeFort MadisonFredericksburgFredoniaGarnavilloGarnerGarwinGilbertvilleGilmoreCityGladbrookGlenwoodGliddenGooseLakeGrangerGreenMountainGreenfieldGrimesGrinnellGrundyCenterGuttenbergHamilton

Questions may be sent to: scholarship@mediacomcc.com6

communities servedYOU ARE ELIGIBLE TO RECEIVE A SCHOLARSHIP IF YOU LIVE IN A COMMUNITY LISTED BELOW

HamptonHardinCo.HarlanHarpersFerryHarrisHartfordHazletonHiawathaHillsHudsonHumboldtHuxleyIndependenceIndianolaIowaCityIowaFallsJanesvilleJohnstonJones Co.KalonaKellertonKensettKeokukKeotaKnoxvilleKossuthLake CityLake ParkLakesideLambsGroveLamoniLansingLa PorteLaurensLe ClaireLeGrandLee Co.LelandLeonLime SpringsLinnLisbonLone TreeLongGroveLoviliaLow MoorLucas LynnvilleMadridManchesterManlyMansonMaquoketaMarengoMarionMarquetteMarshalltownMason CityMaynardMcCauslandMcGregorMelcherMiddletownMilesMills Co.MitchellvilleMonroeMonticello MontroseMorning SunMount JoyMt AyrMt PleasantMt VernonNevadaNewAlbinNewHamptonNewHartfordNewLondonNewSharonNewhallNewtonNorthEnglishNorthLibertyNorthwoodNorwalkNorwayOelweinOkobojiOrleansOsageOsceolaOskaloosaOssianOttumwaOxfordOxfordJct.

Panorama ParkPark ViewParkersburgPellaPerryPleasantHillPleasant ValleyPleasantvillePlymouth(Ne)PocahontasPolk CityPrairie CityPrestonPrincetonRandallRaymondRedOakRedfieldReinbeckRiverdaleRiversideRockwellRockwellCityRuralClintonCo.RuralJacksonCo.SabulaSac CitySagevilleScottSheffieldSheldahlShellRockShenandoahShorewood AcresShueyvilleSigourneySlaterSolonSpencerSpillvilleSpirit LakeStorm LakeStory CityStrawberry PointStuartSullySumnerSwea CitySwisherTamaTiffinTiptonToddvilleToledoTraerUniversityHeightsUniversityParkUrbandaleVan MeterVenturaVilliscaVintonWahpetonWalcottWapelloWashburnWashingtonWaterlooWaukee WaukonWaukon Jct.WaverlyWebsterWebster CityWellmanWest BranchWest BurlingtonWestDesMoinesWest LibertyWestOkobojiWest PointWestUnionWestwoodWhat CheerWilliamsburgWindsorHeightsWintersetWoodburnWoodwardWrightWyoming

KANSASAltoonaBaldwin CityBurlingameBurlington

CarbondaleEdgertonEurekaGalenaGridleyHamiltonLeboLeroyLyndonMadisonMulberryNewStrawnOsageCityOswegoScrantonThayerTorontoTreeceWellsville

KENTUCKYAlbanyAlmoBarrenBee SpringBentonBig CliftyBonnievilleBreckenridge Co.BrownsvilleBurkesvilleButler Co.CadizCaldwell Co.Calloway Co.Calvert CityCaneyvilleCasey Co.Christian Co.ClintonClinton Co.CrittendenCroftonCumberlandDaviessCo.DoverEdmonsonCityEdmontonElktonFordsvilleFredoniaGamalielGilbertsvilleGraysonCo.GuthrieHardinHartCo.HendersonHerdinCo.HopkinsCo.HopkinsvilleLarue Co.Lincoln Co.MadisonvilleMarionMarrowboneMarshall Co.MelwoodMonroe Co.MorgantownMumfordvilleNeboNortonvilleOakGroveOhioCo.Park CityPembrokePickett Co.PrincetonRockcastleCo.RussellCo.Saint PaulSalemSonoraSummershadeSweedenTodd Co.TompkinsvilleTrentonTrigg Co.UptonWhitesville

MICHIGANAlmena Twp.Antwerp Twp.Marcellus Twp.

MattawanMendonMendon Twp.Oshtemo

MINNESOTAAdamsAppletonArlingtonAtwaterAuroraBeaver BayBelgradeBelle PlaineBirdIslandBiwabikBloomfieldBlooming PrairieBrootenBrownsdaleBrownsvilleBrowntonBuffalo LakeBuhlButterfieldCaledoniaCalumet Cannon FallsCanteburyEstatesCantonCarltonChanhassenChatfieldChisholmChokioClara CityClevelandClintonClontarfCloquetCohassetColeraineCollinwood Twp.CookCosmosCreditRiverDakotaDanubeDarwinDassellTwp.DawsonDeephavenDodgeCenterDoverTwp.ElkoEllsworthEvelethExcelsiorFairfaxFayalFlorenceFranklinFuldaGaylordGibbonGilbertGracevilleGrandMaraisGrandRapidsGrandRapidsTwp.GraniteFallsGreenwoodGroveCityHadleyHamburgHancockHarrisTwp.HassanValleyHayfieldHectorHendersonHermantownHibbingHokahHoustonHowardLakeHoytLakesHutchinsonIndependenceIvanhoeJanesvilleKasotaKeewatinKenyonKinneyLafayetteLake Benton

Lake CityLake CrystalLake JeffersonLanesboroLaprairieLeRoyLe Sueur Lester PrairieLitchfieldLitchfieldTwp.Long LakeLonsdaleLorettoLower SiouxLuverneLyleMabelMadisonMantorvilleMaple PlainMarbleMaynardMcKinleyMedinaMidway Twp.MinnetristaMinnetonka BeachMontgomeryMoose LakeMoose Lake Twp.MorrisMorris Twp.MortonMoundMountainIronMountain LakeNashwaukNewMarketNorthRedwoodNorwoodOliviaOronoPaynesville Twp.PaynesvillePembertonPetersonPipestonePrestonPrior LakeProctorRedwoodFallsRiversideTerraceRushfordSaint BonifaciusSaint Charles CitySaint Charles Twp.Saint JamesSaint PeterSavageShorewoodSilver BaySilver LakeSlaytonSleepyEyeSpringGroveSpring LakeSpring ParkSpring ValleySpring Valley Twp.SpringfieldStarbuckStewartSturgeon LakeSunburgSunrise VillaTaconiteThomsonTonka BayTroskyTwoHarborsTylerVeseliVictoriaVirginiaWaconiaWaldorfWalthamWasecaWayzataWebsterWellsWest ConcordWheatonWindemereWinnebagoWinstedWinthrop

WoodlandWorthingtonYoung America

MISSOURIAirportDriveAlbaAlbanyAndersonAppleton CityArchieAshGroveAvaBattlefieldBethanyBillingsBoone Co.BrunswickButlerCaboolCallawayCameronCarl Jct.CarrolltonCaruthersvilleCassvilleClay/RayCo.ColumbiaCraneCrystal LakesDiamondDuenwegDuquesneEvertonExcelsiorEstatesExcelsiorSpringsExeterForsythForsythRuralGoldenCityGoodmanGranbyGreeneCo.GreenfieldHaytiHaytiHeightsHenriettaHermannHoltsSummitHomesteadVillageJasperJasper Co.Jefferson CityJoplinKimberling CityLawsonLiberalLockwoodLowery CityMansfieldMarcelineMarshfieldMillerMt. VernonNeckCityNewtoniaNorborneOronogoOsceloaPurcellPurdyPurdyRuralRichmondRogersvilleSalisburySarcoxieSeymourSpringfieldStark CityStraffordUniv.ofMissouriWalnutGroveWillardWoodHeights

OHIOAntwerpHicksville

OKLAHOMACardinPicherQuapaw

SOUTH DAKOTAArlingtonAuroraBrookingsBruceCastlewoodColmanDesmetEganElktonEstellineFlandreauHaytiLakeNordenLake PrestonVolgaWhite

TENNESSEEBigRockDoverSteward Co.(BigRock)

WISCONSINAlbanyArgyleBelmontBentonBlanchardvilleBoscobel CityBridgeport Twp.BrookviewBrowntownCampDouglasCashtonChaseburgCoon ValleyCrawford Co.Cuba CityDarlingtonEastDubuqueElkhornEssman&AbleFennimoreFerryvilleFootvilleFort MccoyFremontGayMillsGermantownGrantCo.GreenfieldHazelGreenHustlerIolaJuneau Co.La FargeLa CrosseLafayette Twp.LaGrangeTwp.MartintownMaustonMonticelloMuscodaNecedahNewLisbonNorwalkOntarioOrfordvillePotosiPrairieDuChienReadstownRichlandCo.ScandanaviaShelbyShullsburgSoldiersGroveSouth WayneStoddardSugar CreekTennysonVernon Co.ViolaViroquaWestbyWilton

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8

referencesREFERENCES FOR THE SCHOLARSHIP CANDIDATE

Please print the information below:

Nameofcandidate_________________________________________________________________________________________________________

Yourname________________________________________________________________________________________________________________

Yourrelationshiptothecandidate___________________________________________________________________________________________

Please rank the candidate in each of the categories below by circling the appropriate number for each item.

ThecandidatemustmailthisandallotherapplicationmaterialsonorbeforeFebruary15,2012.

RATING SCALE

Ratethecandidatecomparedtothetypicalstudentinyourschool.

4-Outstanding3-AboveAverage2-Average1-BelowAverage

•Leadershipinschool 4 3 2 1

•Leadershipincommunity 4 3 2 1

•Characterandintegrity 4 3 2 1

•Self-reliance 4 3 2 1

•Initiative 4 3 2 1

•Creativity 4 3 2 1

Iherebydeclarethattheaboveinformationisaccuratetothebestofmyknowledgeand/oropinion.

Signatureofpersoncompletingthisform______________________________________________________Date_________________________

THANKYOUFORYOURCOOPERATION.

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referencesREFERENCES FOR THE SCHOLARSHIP CANDIDATE

Please print the information below:

Nameofcandidate_________________________________________________________________________________________________________

Yourname________________________________________________________________________________________________________________

Yourrelationshiptothecandidate___________________________________________________________________________________________

Please rank the candidate in each of the categories below by circling the appropriate number for each item.

ThecandidatemustmailthisandallotherapplicationmaterialsonorbeforeFebruary15,2012.

RATING SCALE

Ratethecandidatecomparedtothetypicalstudentinyourschool.

4-Outstanding3-AboveAverage2-Average1-BelowAverage

•Leadershipinschool 4 3 2 1

•Leadershipincommunity 4 3 2 1

•Characterandintegrity 4 3 2 1

•Self-reliance 4 3 2 1

•Initiative 4 3 2 1

•Creativity 4 3 2 1

Iherebydeclarethattheaboveinformationisaccuratetothebestofmyknowledgeand/oropinion.

Signatureofpersoncompletingthisform______________________________________________________Date_________________________

THANKYOUFORYOURCOOPERATION.

10

past scholarship winners2011 WINNERS

ArizonaKelleyGullo–QueenCreek

CaliforniaBonnieCoit–HiddenValleyLakeAmyLee–Ridgecrest

Iowa Katelyn Connick – AlgonaEmilyJudd–AdelElaineGodfrey–BurlingtonAveryHunter–CharitonAshely Willms – Clear LakeHannahMcAtee–DavenportAaronBaughman–DenisonAmandaIngoli–DesMoinesRachelKleitsch–FairbankAnthonyFlattery–FortDodgeLaurenOpp–GarnerDJSavarese–GrinnellShaunaHappel–HiawathaAlexanderHjelmaas–JohnstonKelseySchieltz–MadridShelbyWirth–MaquoketaAnneEpleyBirtwistle–MasonCityTarra Troendle – SwisherAlenKajtezovic–WaterlooBrady Campbell – WaukeeAndrew Withers – WaverlyPaige Burkhart – Woodward

Illinois Jordan Smith – SomonaukAdrianneBishop–GiffordHannahWood–CartervilleKimberly Wenger – FairburyRachelYoung–HerrinMark Miller – Savanna

Indiana Shelby Leichty – AuburnDustinArvola–ChurubuscoJordan Leising – BlufftonHopeJordan–Bremen

Kentucky JeremyEdmonds–BentonLauren Chism – Morgantown

Minnesota Valerie Kloeckl – ArlingtonAmyKampa–GrandRapidsJill LaBine – KeewatinDanielElmer–Wells

Missouri Benjamin Brown – Appleton CityMitchellHatten–CameronKatelyn Tschiggfrie – ColumbiaRyanBax–JeffersonCityReneeRichter–Springfield

South Dakota Jackson Steinkamp – BrookingsSpenser Foster – Flandreau

TennesseeAmberAdams–BigRock

WisconsinLukeEverson–LaCrosse

2010 WINNERS

CaliforniaDaniellePappe–InyokernGeorgeCockerton–LakeportKaitlinHeinen–Eldridge

Iowa JenniferVong–DesMoinesAmelAbdiBare–DesMoinesRyanFrancois–DesMoinesJosephLampe–OsceolaBrentSexton–RockwellCityTaylor Anderson – Storm LakeMaryRowley–UrbandaleDhrootiVyas–UrbandaleEmmalineWright–VilliscaJacklynEngelbart–AnamosaAdheshwariRamesh–CedarRapidsLukeDenlinger–DubuqueKristin Canning – LisbonKristenHora–RiversideAndrewRichter–WaterlooShanel Wermerskirchen – WaterlooChantal Knepper – Williamsburg

Illinois JohnPatrickBrown–EastMolineNicoleWenger–FairburyKevinJohnson–RockIslandAmeliaMartens–OrionCourtneyDufford–StocktonKatelynBrozak–StreatorShawnaWagley–HerrinSamuel Martin – CartervilleJohn Cross – Mound City

Indiana DeborahOhiani-Jegede–Merrillville

Kansas Kaitlin Meyer – LeroyNathaneilJohnson–BurlingameLogan Buter – Albany

Michigan ShaneRussell–Mendon

Minnesota OliviaBlinn–CloquetMackenzieRein–CookBreannaWalker–GrandRapidsWiphawiSiriphatthanaphinyo–HutchinsonLindsay Summers – JanesvilleBethOchs–Franklin

Missouri LanaeFlatness–SpringfieldEmilyWhitmarsh–MountVernonMatthewNewman–JasperShelbyNoll–Salisbury

South Dakota RobertFrancis–BrookingsAnne Parsley – Flandreau

WisconsinOliviaWedig–DarlingtonBrent Mecikalski – FremontAlexander Siemers – La Crosse

2009 WINNERS

IowaEmilyAnderson–AnkenyErikaDavis–SigourneyEthanKilburg–MaquoketaHaleyStreff–UrbandaleJordanHutchens–DesMoinesJordanHarbaugh-Williams–WaterlooKalliHannam–MarshalltownMallorySturtz–NewtonMythili Prabhu – AmesNathanBleadorn–WaverlyRaeannShimak–MasonCitySarahDooley–BettendorfSethNicholson–DikeShelby Sieren – KeotaShelbyEaton–DubuqueSimoneRenault–ClintonTodd Lyon – ToledoTylerGustafson–SpiritLake

Illinois ErikaLawson–DavisGabrielleSpeybroeck–EastMolineGrantPierce–StocktonKaseyNelson–OttawaTaraVandygriff–RockIslandShiann Poshard – Pontiac MalloryLivezey–CheonaBrittanyBroadwater–DwightCorey Sharp – LexingtonKara Johnson – PaxtonKaylee McCollum – LouisvilleJodieLatham–OaklandNicholeRush–JacksonvilleMolly Stice – JacksonvilleWyattTheodoreGard–MartinsvilleSarahOdle–MarionTali Kasser – Carbondale

IndianaKassidi Van Allen – KendallvilleMeghan Sproch – AngolaIlaA.Jackson–WalkertonJessicaGoldsmith–SyracuseCrystalPearce–NorthJudson

Kansas Allyson Sass – Baldwin City

KentuckyErinOakley–CadizJordanHenson–Burkesville

Minnesota Katelin Strand – Blooming Prairie

MissouriZacharyBaughman–CarlJunctionClintDeNisco–Mr.VernonBradyChoat–SpringfieldDavidWaites–SpringfieldElizabethDarter–CaboolRobertPowers–ExcelsiorSpringsLori Beitsch – ColumbiaLindsey Buschjost – Jefferson CityAlex Turner – ColumbiaViraj Patel – Caruthersville

South Dakota LindsayHieb–Brookings

Wisconsin HillaryHartley–SoldiersGroveMeganNeitzel–CampDouglas

11

past scholarship winners2008 WINNERS

IowaAngelaMarquard–HamptonAnnaStatz–BooneBrianDarling–ToledoChloeDedic–MasonCityDakotaHoben–WapelloEmilyFelkner–CentervilleEthanGingerich–IowaCityIanMitchell–NewHamptinJacquilynErickson–HarlanJared Johnson – CrestonJasmine Chen – AmesJillMcFee–GrinnellJohnBuzynski–HudsonJohnSchulz–CedarRapidsJoseph Toale – SpencerJustin Cullen – Storm LakeKalliMartin–DubuqueMeganBalek–NewtonMichelle Wallace – JohnsonMickael Streicher – Cedar FallsRobertHumble–EsthervilleSamuelWagner–DavenportSaraWise–DesMoinesShaziaDharssi–CedarRapidsTrevorJohnson–CedarRapids

Illinois FionaMcGowan–ChillicotheJacobKuban–GeneseoJeff Liles – LenaJoel Sedlacko – StreatorMargaret Modica – Lena

Minnesota AmandaImberg–DasselDonaldFahey-Ahrndt–NorwoodYoungAmericaElizabethTroolin–HermantownJonnicaNorell–St.PeterKaylaNygaard–CannonFallsMichaelJordan–Hibbing

South Dakota Benjamin Kantack – BrookingsRachelRemund–Elkton

Wisconsin AbigailWedig–DarlingtonKelli Fischer – Argyle

2007 WINNERS

Iowa Alyssa Beatty – CharitonAshleyPetersen–DavenportEdwardOvery,Jr.–ManlyElizabethWalsh–CrestonEmilyRichards–DubuqueFarihaChowdhury–DavenportGabrielParker–Mt.VernonGreenBouzard–WaverlyHayleyNorton–TiptonHeidiWelsh–WilliamsburgJanelle Vittetoe – WashingtonJaredGebol–NewHamptonJasonDavis–DavenportJennifer Compton – AmesJohnJessen–DesMoinesJohnKohorst–HarlanJordanKing–DavenportJoshua Strief – Sac CityKari McCann – CrestonKelly Wenman – CoralvilleKristin Wilson – LoviliaLindsay Stoll – Spirit LakeLisaGudenkauf–CedarRapidsNicoleStoll–CrestonPaulNelson–IowaCityRyanBudding–WiltonShreyaMadhavaram–CedarRapidsStephanieLeinen–DesMoinesTaylorSeemuth–IowaCityTyler Miller – Mt. PleasantVanessaShiu–IowaCityYouranYe–WestDesMoines

Illinois Brittney Kajdacsi – ColonaEvaHoffrichter–PontiacHeidiIsermann–StreatorLauren Marshall – FairburyMatthewGonitzke–RockfordMelanieLindell–GenescoShannon Failia – KirklandSkylar Kempel – LenaToddEpps–GibsonCity

Minnesota Christina Miles – VictoriaJeffreyBuchwitz–VirginiaJoelleElmer–WellsLauraJensen–NorwoodYoungAmericaLauraNorthrup–WaconiaMiaJohnson–Duluth

Wisconsin Angela Walhovd – MaustonBrookeAnderson–IolaKaleeCrist–Darlington

2006 WINNERS

IowaAlexanderSalem–WestDesMoinesAmandaEikenberry–DesMoinesAmyXu–FortDodgeAndrew Jennett – CrestonBrandonGoodman–BooneBrentMiller–RockwellCityCaitlinHerrnstadt–AmesCaitlinNiggemeyer–MaynardCalliFriesen–IowaFallsCatherineGardner–OttumwaChristinaSchiltz–CliveElizabethStaloch–OttumwaEmilyWarford–DesMoinesHeidiRamaeker–CrestonHungBui–DesMoinesJamesZhang–FortDodgeKarla Fisher – CrestonKathyrnHeiar–ManchesterKatieYourstone–UrbandaleKristinHanson–MasonCityLauraKuennen–NorthwoodMarisaErlandson–SpiritLakeMeganDeahr–HumboldtMeganSkinner–DesMoinesMeredithHobson–UrbandaleMeredithRitter–UrbandaleRobRomero–AltoonaSamanthaToole–DesMoinesSarahCramer–DesMoinesSarahSchlitter–GladbrookSpencer Pflum – BurlingtonThomasGrooms–DesMoinesWhitney Carson – Swisher

Illinois BriannaMartinez–LenaKatherineCain–EastDubuqueKathrynStaver–Galena

Minnesota Alissa Jansen – St PeterBriannaFrey–HoytLakesBrittanyGentzler–PipestoneJamieKallestad–CloquetJohn Weitgenant – WorthingtonKelsey Loeger – PipestoneLauraEngman–MountainIronLaura Valdmanis – Prior LakeLaura Kloeckl – Arlington

South Dakota Allison Struck – YanktonEmilyTschetter–BrookingsHannahAlsgaard–Yankton

Wisconsin Joseph Steiner – PotosiMartina Logan – Mauston

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