BEAU ISKE INSURANCE AGENCY SCHOLARSHIP DUE DATE FOR THIS SCHOLARSHIP IS: February 1 st

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1 BEAU ISKE INSURANCE AGENCY SCHOLARSHIP DUE DATE FOR THIS SCHOLARSHIP IS: February 1 st Beau Iske Insurance Agency Inc has been serving the Millard area for insurance since Representing State Farm Insurance Companies, we are proud of our history and roots here in the Millard community. Gerald Iske started with insurance in 1962 at 128 th and Q Street. In 1990 Beau Iske (his son) started his agency at 138 th and Q Street. Both Father and Son have been very active in the Millard community and in appreciation of their longevity and success, would like to give back with this scholarship to help out the next potential business student. Our goal is to find a student in good academic standing, active in activities in school and working in accordance with teachers and administration. Our goal is to help them achieve their dreams with this money used toward their tuition. SPECIAL REQUIREMENTS: 1. One $ scholarship will be awarded annually to a graduate of each of Millard West High School. The award will be renewable for two years, subject to meeting requirements. 2. The applicant must have participated in two or more school clubs or activities. 3. Shall have a 3.0 grade point average, or higher, at the end of the first semester of the senior year. 4. Must obtain two (2) recommendations from teachers using the Teacher Rating Scale. 5. Must not be receiving more than $5, in combined scholarship awards. 6. Must plan to attend a two or four year institution. 7. All completed applications must be returned by the student applicant to: Millard Public Schools Foundation, 5225 S. 159 th Avenue, Omaha, NE, 68135, by February 1st. Please use this signed document as the cover sheet for your application. IMPORTANT NOTE TO APPLICANT: Respond to the following topical requests (sections A through D) by setting up the topic headings and specific information accompanying each one on a separate attachment. You may put more than one topic on a page. Provide your response to each topic in a neat, well organized manner. Allow one line of space between the topic request and your response. Sections A through D must be typed or computer printed. Do not repeat the same information in more than one section. A. Importance of being involved in school activities Write a 200 to 350 word statement on the subject, Why I think it is important to continue my education. B. School Related Experiences List all school clubs and activities (music, athletics, plays, etc.) in which you participated during your elementary, middle school, and senior high school years. Indicate the specific years of participation and the title of any leadership positions held or awards or special recognition received. Please list the name of the coach/sponsor/mentor that impacted you the most. C. Personal and Community Activities List the activities and hobbies that you actively pursue. Do not duplicate any of the activities described in the previous question. Examples are: photography, painting, skating, music, church and other activities. D. Work Experience List work experience and summer employment that you have held. Also list any volunteer work that you have not previously reported. Give specifics on the number of hours worked and duration of the jobs. Include an explanation of duties and responsibilities if not self-explanatory. Checklist for completion of this application: [ ] I have provided my Teacher Rating Scales to and. I realize that teachers should receive the rating scale at least 7 days prior to the due date. I reminded them to return the Teacher Rating Scale to the Millard Public Schools Foundation prior to February 1st. [ ] I have completed all parts of the application, including the essay. REQUIRED: We certify by our signatures below that the responses on this application, including those on the attached sheets, are true and factual and that we have read and understand the application requirements for this scholarship and the criteria for accepting it.

2 Student Applicant Parent or Guardian Counselor MILLARD PUBLIC SCHOOLS FOUNDATION MEA SCHOLARSHIP TEACHER RATING SCALE This recommendation is for:_ Scholarship due date is: February 1st Student's name Instructions to the Student: --Print your name in the space provided above, and mark an X next to your high school I attend: ( ) Millard North High School, 1010 So. 144th Street, Omaha, NE ( ) Millard South High School, "Q" Street, Omaha, NE ( ) Millard West High School, 5710 So.176th Ave, Omaha, NE Instructions to Evaluator: -----Mark an X in each category below that best describes the student One of the top Name of No Basis Below Average Above Excellent Outstanding 2-3 students Category To Eval. Average Average Top 10% Top 2-3% in my career CREATIVE ORIGINAL THOUGHT [ ] [ ] [ ] [ ] [ ] [ ] [ ] INDEPENDENCE, INITIATIVE [ ] [ ] [ ] [ ] [ ] [ ] [ ] INTELLECTUAL ABILITY [ ] [ ] [ ] [ ] [ ] [ ] [ ] ACADEMIC ACHIEVEMENT [ ] [ ] [ ] [ ] [ ] [ ] [ ] WRITTEN EXPRESSION OF IDEAS [ ] [ ] [ ] [ ] [ ] [ ] [ ] EFFECTIVE CLASS DISCUSSION [ ] [ ] [ ] [ ] [ ] [ ] [ ] DISCIPLINED WORK HABITS [ ] [ ] [ ] [ ] [ ] [ ] [ ] RESPONSIBILITY [ ] [ ] [ ] [ ] [ ] [ ] [ ] PERSERVERANCE, INDUSTRIOUSNESS [ ] [ ] [ ] [ ] [ ] [ ] [ ] CITIZENSHIP [ ] [ ] [ ] [ ] [ ] [ ] [ ] DEPENDABILITY [ ] [ ] [ ] [ ] [ ] [ ] [ ]

3 Teacher: Please sign your name If you wish to make any additional comments, check this box [ ] and use the back of this sheet. TEACHERS: PLEASE RETURN THIS FORM TO THE MILLARD PUBLIC SCHOOLS FOUNDATION, 5225 S. 159 TH AVENUE, OMAHA NE By Feb. 1 st Deadline

4 MILLARD PUBLIC SCHOOLS FOUNDATION GENERAL SCHOLARSHIP APPLICATION FORM General Requirements: 1. The scholarship must be used for undergraduate study at an accredited university, college, or other post secondary educational institution of the recipient's choice. The award winner must begin attendance at the selected institution by October in the year of high school graduation. 2. Criteria that will be applied to the selection process for this scholarship include, but are not necessarily limited to the following. The Student Applicant: a. Shall have participated in school and community activities during his/her high school career. b. Must be eligible to graduate from a Millard Public high school by June of this year. c. Shall have not been awarded, nor will be awarded by August 15th of this year, any ONE scholarship having a value equal to or greater than one year's total cost (full ride) at the institution in which they enroll. If such award is accepted AFTER submitting this scholarship application, it becomes the obligation of the recipient to report this fact to the Millard Public Schools Foundation. The Millard Public Schools Foundation will then award the scholarship to an eligible runner-up. d. Must submit this fully completed application in order to be considered for this scholarship. 3. This scholarship is funded through contributions to the Millard Public Schools Foundation. 4. All applications must be typed or computer printed. All parts of this application are to be completed by the applicant only. 5. If the due date falls on a Saturday, Sunday, holiday or other non school day, the application is due by 10:00 A.M. on the next day that school is in session after the due date. 6. The scholarship award winner and an alternate will be determined no later than March 1st by a selection committee established by the donor of this scholarship. The names of the winner and the alternate will be reported to the Millard Public Schools Foundation by March 1st. All applications and supporting information will become the property of the sponsor, who will have discretionary authority in all matters pertaining to this award. Award winners will be notified by the Millard Public Schools Foundation during the month of April. 7. Funds will be disbursed during the months of August and September. The scholarship check will be made payable to the student applicant, upon receiving verification of enrollment. Verification of enrollment must be provided by the Office of the Registrar of the college or university that the student will be attending. Checks will be issued through the Millard Public Schools Foundation. 8. The student applicant is directly responsible for delivering or mailing this completed application to the address indicated in the special requirements section.

5 Page 2 (Millard Public Schools Foundation General Scholarship Application Form) Applicant Name: Address: City, State, Zip: Applicant Preferred Number: Applicant Millard Schools Attended: Elementary: Grades Attended: Elementary: Grades Attended: Middle: Grades Attended: Middle: Grades Attended: High School: Grades Attended: High School from which you will graduate from: Institution you are planning to attend this fall. If you are considering more than one, please list in the order of preference: Parents/Guardians (Please indicate if parent is deceased) Father/Guardian s Name: Address (If different from students) City, State, Zip: Preferred Telephone: Father/Guardian s .. Mother/Guardian s Name: Address (If different from students) City, State, Zip: Preferred Telephone: Mother/Guardian s G.P.A.. CLASS RANK OUT OF ACT COMPOSITE SCORE: SAT Student Applicant Signature Parent or Guardian Signature Counselor s Signature