• All materials listed on this sheet must be submitted at the same time in one packet, accompanied by this checklist to the Stateline Community Foundation, ATTN: Tammy Kerch, 121 West Grand Avenue, Beloit, WI 53511. All materials must be received no later than midnight on March 7th, 2010. Incomplete or late applications will not be considered.
• Only one copy of required materials is necessary, regardless of the number of scholarships for which you are applying. Do not staple your application materials. Please use paperclips only.
• The names of recipients of scholarships administered by the Stateline Community Foundation are listed in the organization’s annual report, on the website, and may be included in other promotional materials.
• Recipients are expected to attend the scholarship award ceremony on Saturday, May 15th at 11:30 a.m. at the LaCasa Grande Banquet Facility, 618 4th Street, Beloit
• Contact Tammy Kerch by email at tammy@statelinecf.com with any questions

• This checklist
• Resume
• Official high school transcript in a sealed envelope
• Two completed (non-family member) recommendation forms – Each must be in a sealed envelope with the recommender’s signature on the seal (recommendation form )
• A copy of your Student Aid Report (SAR) compiled from your Free Application for Federal Student Aid (FAFSA) Form (www.fafsa.ed.gov )
• Senior picture
• Any additional documentation required of specific scholarship (Scholarship Summaries )

I certify that:

• I meet the eligibility requirements for each scholarship for which I am applying
• The application packet is complete
• The information on this application is true and accurate to the best of my knowledge
• The essay I submit is my original work
• I authorize my high school to release academic, financial and/or other necessary information as required by the donor and/or the Stateline Community Foundation
• By signing this form I authorize the Stateline Community Foundation to use this application and any supporting documents for promotional purposes

Student Signature & Date:__________________________________________________________