Class of 1967 Scholarship Application

$6,000.
00 SCHOLARSHIP
$1,500.00 Freshman Year Award, Paid in Two Installments
Opportunity for six (6) additional bi-annual awards of
$750.00 each, for a total of $6,000.00 distributed over 4-years.
The Harrison Class of 1967 Scholarship was created for dedicated, hard-working, compassionate students.
This gift is intended for a slightly above average Senior who may not qualify for traditional scholarships.
An individual who has enjoyed a well-rounded high school experience, both academically and through
involvement in school activities, while making a positive impact on the community through vocational
employment and/or volunteer efforts.
Community is important to the Class of 1967.

To qualify for this scholarship, the recipient must plan to obtain a degree from one of the following
local schools: University of Southern Indiana, University of Evansville, Ivy Tech Community College or
a local trade school. This requirement ensures both the recipient and the community will benefit.
SCHOLARSHIP APPLICATION
Student First Name (Given)*
Student Middle Name*
Student Last Name*
Student Preferred Name*
Student Mailing Address*
Street
City
State Postal Code
Student Email Address*
Student Mobile Telephone*

1. POST-SECONDARY EDUCATION Local college or trade school
List, in order of preference, the college or trade school you wish to attend
Applied yes no Accepted yes no
2. HIGH SCHOOL ACTIVITIES & COMPETITIONS Band, Sports, Student Government, Arts, Clubs, Organizations
School Year(s) Activity Role in Activity
3. COMMUNITY INVOLVEMENT (Non-Compensated Activities) Civic, Volunteer, Organizations, Clubs, Scouting

School Year(s) Organization and Contact Person Type of Involvement
4. WORK EXPERIENCE I. Employment while school is in session

Date(s) Hours/wk Company/Organization Supervisor Duties
5. WORK EXPERIENCE II. Summer Employment

Date(s) Hours/wk Company/Organization Supervisor Duties
STUDENT ESSAY Tell us a little bit about yourself. What motivates you to continue your education after high school?
Have you chosen a major or type of degree you plan to obtain? Have you chosen a career path and set goals for your future?
ADDITIONAL INFORMATION Use the following to complete sections 1-5 if more space is required.
Please list section number(s), when applicable.
By placing my signature, below, I testify the information contained in this application is true and accurate. I realize that
intensionally providing false information could render me ineligible to receive the scholarship grant. I further understand and
agree that once submitted, this application and its contents become the property of the Class of 1967 Scholarship organization.
Signature of Student Signature of Legal Guardian, if under 18 Date

Typed name serves as legal signature
INSTRUCTIONS
The Harrison Class of 1967 Scholarship is presented during the May Honors Night
Ceremony.
Instructions regarding initial and future redemptions will be emailed to the recipient at the
address provided on this application. Should contact information change, please notify one
of the individuals, listed below.
IMPORTANT: Recipient must acknowledge acceptance of this scholarship within two-
weeks of Honors Night. Failure to do so may result in the re-assignment of this
scholarship. Acceptance must be in the form of a PDF attachment emailed to Becky
Dumes using the address provided, below.
Please direct all correspondence, including questions concerning this application and/or
scholarship award, to one of the following scholarship administrators listed below:
Becky Dumes
Scholarship Committee Chair
Rdumes12@gmail.com (preferred method of contact)
407.951.8332
David Davies
Scholarship Committee
dave@dkdengineering.com (preferred method of contact)
812.459.1341
APPLICATION CHECKLIST
An interview with the Class of '67 scholarship selection committee will not
be granted to students who submit an incomplete application and/or fail
to provide requested items and documentation.
Review application to insure all questions, including the Student Essay

section, are accurate and complete.
Student Aid report from FAFSA must be emailed with application.
A current, billfold-size photo is also required.
Optional: Letters of recommendation from teachers, activity supervisors,

employers or other individuals writing a letter of reference or
recommendation for you.
Application must be completed and submitted to Becky Dumes no later

than Friday March 5, 2021.

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$6,000.

Community is important to the Class of 1967.

Student First Name (Given)*

Student Middle Name*

Student Last Name*

Student Preferred Name*

Student Mailing Address*

State Postal Code

Student Email Address*

Student Mobile Telephone*

Applied yes no Accepted yes no

Applied yes no Accepted yes no

Applied yes no Accepted yes no

School Year(s) Activity Role in Activity

3. COMMUNITY INVOLVEMENT (Non-Compensated Activities) Civic, Volunteer, Organizations, Clubs, Scouting

4. WORK EXPERIENCE I. Employment while school is in session

5. WORK EXPERIENCE II. Summer Employment

Signature of Student Signature of Legal Guardian, if under 18 Date

Review application to insure all questions, including the Student Essay

Student Aid report from FAFSA must be emailed with application.

A current, billfold-size photo is also required.

Optional: Letters of recommendation from teachers, activity supervisors,

Application must be completed and submitted to Becky Dumes no later

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