Home Bank SB Scholarship Applicant Instructions

Please read the entire list of instructions below carefully. Incomplete applications or applications with missing information and attachments may not be considered.

1. To be eligible, you must be a high school senior planning to attend full timeundergraduate studies or a current full time undergraduate student at an accredited twoyear or four year college, university, vocational or tech school in Indiana for the entireupcoming academic year and an active account holder at Home Bank sb. (Children,grandchildren and siblings of Home Bank SB employees are not eligible)

A total of three scholarships in the amount of $1,000.00 each will be awarded. In addition, Home Bank will donate $500 in the name of each winner to a 501(c)3 non-profit organization of his/her choice . If selected as a recipient, you must provide proof of enrollment to a two year or four year college, university, vocational or tech school in Indiana.

2. Application and essay must be typed or legibly printed in blue or black ink.

3. Please complete and submit the original application and required attachments, assembledin the following order:

A. Scholarship Application (3 pages)B. Copy of your Cumulative High School Grade TranscriptC. Essay (2 pages)D. Two letters of recommendation from non-relatives

• One from an educator• One from a person in your community

4. Make a copy of your completed application and attachments for your own records.

5. Questions should be directed to Tana Lobb at Home Bank. Contact information is listedbelow.

Applications and required attachments must be sent together and received by noon on Friday, April 15, 2016.

To hand deliver application, please make arrangements with:

Tana Lobb Home Bank 670 Birk Road Martinsville, IN (765) 558-3804tlobb@homebanksb.com

To mail application, send to:

Tana Lobb Home Bank PO Box 1677 Martinsville, IN 46151

Home Bank sb Scholarship Application Form

Section I: Applicant Information Name:

Last First Middle

Permanent Street Address:

City/Zip:

Phone: Date of Birth:

High School:

Graduation Date:

Section II: Education Information * Current High School GPA:

Current Class Rank: SAT Score: ACT Score:

Academic Honors Diploma? YES NO

Days Absent in 9th grade: Days absent 10th grade:

Days Absent in 11th grade: Days absent 12th grade:

* You may need to consult your school’s administration to answer these questions.

Section III: Post-Secondary Information

Name of college or university you are planning to attend:

Street Address:

City/State/Zip:

Major, Program, or Field of Study:

Have you been accepted? YES NO

** Have you received other scholarships to support your attendance at this college or university? YES NO

** If yes, please specify $ amount(s) and source(s) of scholarships received.

Closely follow the below directions to properly complete the below fillable PDF:1. Download the form to your desktop and save to your personal computer.2. Close form3. Reopen saved document on your computer, fill out, and save the form.4. Print and mail or drop off application to Tana Lobb at the address listed on page 1 OR email application and

additional requested documents to tlobb@homebanksb.com.

______________________________________________________________________________

Section IV: Family and Household Information

Please answer the questions below regarding to the household in which you currently live.

Number of full-time college students living in household Number of high school students living in household Number of middle school students living in household Number of elementary school students living in household Number of pre-elementary school students living in household Number of full-time workers living in household

Does applicant work full-time Number of part-time workers living in household

Does applicant work part-time

Place an “X” next to the category that indicates your gross household annual income, including child support, social security, and disability income.

Under $20,000 $51,000 – 65,000 $21,000 - $30,000 $66,000 - $80,000 $31,000 - $40,000 $81,000 - $99,000 $41,000 - $50,000 $100,000 or more

Section V: School and Community Activities In the table below, list school & community activities (including church and volunteer activities) in which you have participated during the past 4 years. Begin with the most recent activity in which you have participated. If needed, an additional sheet may be attached.

Organization and Activity Number of Years

Currently Involved?

(Yes or No)

Leadership Positions, Awards, Recognition

Section VI: Work Experience Using the table below, list work experiences in which you have participated during the past 4 years. Begin with your most recent or current position. If needed, an additional sheet may be attached.

Employer Hrs per week

Dates of Employment

Nature of work

I hereby affirm that the information provided on this form is accurate and complete to the best of my knowledge.

Applicant’s Signature Date

Parent/Guardian Signature Date

Home Bank sb Scholarship Application Essay

Please write a brief typed essay in a separate document (maximum of 2 pages, with no less than 1 inch margins and 12 point font) in response to the essay question below. Be sure to attach this essay to the scholarship application form.

In your own words, explain the importance of community involvement. How have you served your community and how do you plan to serve the campus you plan to attend?