2015 IAA FOUNDATION SCHOLARSHIP APPLICATION

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1 2015 IAA FOUNDATION SCHOLARSHIP APPLICATION Thank you for your interest in the IAA Foundation 2015 scholarship program. Please read the following guidelines and take care to follow all instructions. We look forward to reviewing your application. All applicants must meet these eligibility guidelines: 1. Must be a high school graduate or graduating in Must be an Illinois Farm Bureau member, spouse of member, or member's child and a resident of Illinois. Exception includes the Gourley, Southwell, and Capps Memorial Scholarships (Prairie Farms Dairy) and the St Louis District Dairy Council Scholarship 3. Must be accepted for enrollment or be enrolled at an accredited college, university, or community college. 4. Must exhibit potential for successful completion of course of study. 5. May not be the spouse, child, sibling, grandchild, son-in-law, or daughter-in-law of an IAA Foundation Trustee, employee, or current member of the Illinois Farm Bureau Board of Directors. Applicants may be previous recipients of an IAA Foundation scholarship. An applicant may apply for more than one, but can only receive one of the following scholarships. Only one application form is needed to apply. In addition to the above guidelines, specific requirements for each scholarship are listed below: Illinois Farm Bureau Legacy of Leadership Scholarship (One $7,500 scholarship awarded) o Must attend a four year university in the state of Illinois with an active agriculture college or department (University of Illinois, Southern Illinois University, Western Illinois University, or Illinois State University) o For matriculating college juniors (students beginning their junior year-60 credit hours) or transfer students beginning their junior year who are accepted at one of the universities as a junior) o Major in a field related to direct support of the agricultural industry o Proven leadership experience in high school and college years with an emphasis on college activity o Achieved a cumulative GPA of 3.4 or higher o Priority given to an individual who is actively engaged in Illinois Farm Bureau activities o Additional essay required: In 250 words, please explain: My vision for the future of agriculture and how I plan to contribute through the qualities & experiences in leadership I possess. IAA Foundation General Scholarship (A total of seven scholarships awarded) Three $7,500 General Scholarships awarded: o Major must be in agriculture, agribusiness, or an ag-related field o Must be accepted for enrollment or be enrolled at an accredited college, university, or community college in the state of Illinois One $1,100 scholarship in the name of Robert F. Rouse o Major must be in agriculture, agribusiness, or an ag-related field at any accredited post-secondary institution with an active agriculture college or department Two $1,000 scholarships in the name(s) of Fletcher A. Gourley and Leonard Southwell o Major must be in agriculture, agribusiness, or an ag-related field at any accredited post-secondary institution with an active agriculture college or department One $1,000 scholarship for a Western Illinois University student o Major must be in agriculture, agribusiness, or an ag-related field Fletcher A. Gourley, Leonard Southwell & Roger Capps Memorial Scholarship (Six $2,000 scholarships awarded to children of current patrons, and six $2,000 scholarships awarded to children of current employees) o Open to any major, qualified applicants are children of Prairie Farms Dairy patrons as well as children of employees of Prairie Farms Dairy and its subsidiaries (but not joint ventures). A minimum of three years as a patron or employee is also required. The three year minimum is determined as of the application deadline date (February 1, 2015). Greg Carney Scholarship (One $1,500 scholarship awarded) o Open to University of Illinois (Champaign-Urbana) students majoring in agriculture o Must be actively involved in production agriculture in a family farm operation o Must be a current or former active 4-H member Dorothy and Wilhemine Ratermann Scholarship (25 $1,200 scholarships awarded) o Open to any major, recipients must be a son or daughter of an Illinois Farm Bureau member, and a resident of an Illinois county south of, and including, Calhoun, Greene, Macoupin, Montgomery, Christian, Shelby, Cumberland, and Clark.

2 Robert F. Rouse Scholarship (Two $1,100 scholarships awarded) o Preference given to Lake County, IL residents, but open to any student in Illinois o Must attend an accredited post-secondary institution in the state of Illinois; Must be a U.S. citizen o Major must be in agriculture, agriculture related fields, or nursing Dale E. Butz Scholarship (One $1,000 scholarship awarded) o Must be a post-secondary student with a background in production agriculture who is majoring in agriculture, agribusiness, or an agriculture related field Heartland NAMA Steven A Hammerschmidt Memorial Scholarship (Two $1,000 scholarships awarded) o For junior or senior level college student majoring in agriculture or agribusiness interested in a career in agriculture marketing, agriculture sales, or agriculture communications o One scholarship awarded to an Illinois State University student and one scholarship awarded to a University of Illinois student; Must be a U.S. citizen o Additional essay required: In 250 words, please explain: Why I want a career in agriculture. Illinois Award Scholarship (One $1,000 scholarship awarded) o Must be graduating high school senior accepted at an accredited post-secondary institution and majoring in agriculture or an agriculture related field o Priority will be given to students from Cass, Morgan, Stark and Henry counties William J. Kuhfuss Memorial Scholarship (One $1,000 scholarship awarded) o Must attend an accredited post-secondary institution in the state of Illinois; Must be a U.S. citizen o Preference given to students from an agricultural background or working toward an occupation in or related to the field of agriculture St. Louis District Dairy Council Scholarship (Two $1,000 scholarships awarded) o Open to any major, qualified applicants are producers whose check off funding is directed to the St. Louis District Dairy Council. Producer s children and spouse are also eligible. o Student must be enrolled for full time or part time study in an accredited community college, college or university in any degree program. o Illinois Farm Bureau membership is not a requirement for this scholarship o Spouses, children, siblings, grandchildren, and sons-or daughters-in-law of employees of St. Louis Dairy Council are not eligible o Additional essay required: In 250 words, please explain: How dairy farming has impacted my personal skills and character. Walter J. and Martha J. Wills Scholarship (One $1,000 scholarship awarded) o Must be student accepted at or attending Southern Illinois University with a major in any agriculture program except equine, floriculture, or forestry o Must be U.S. citizen whose parents live on and operate a farm In addition to eligibility guidelines, the following considerations are taken in selecting recipients: 1. Scholarship (30%) - Academic performance and honors - ACT score or SAT score 2. Activities and Leadership (30%) 3. Financial need and evidence of self-help (How the student is contributing financially to his/her education) (10%) 4. Strength of Personal Statement (20%) 5. Strength of References/Endorsements (10%) 6. Exceptional Circumstances (up to +10%) 7. Demonstrated interest in agriculture and agribusiness reflects in higher scoring of activities and leadership, personal statement, and references (Exception includes the Ratermann scholarship, Gourley, Southwell, and Capps Memorial scholarship (Prairie Farms Dairy), and the St Louis District Dairy Council scholarship.)

3 IMPORTANT CHECKLIST All students must provide his or her most current transcript. Additionally, students entering Freshman or Sophomore year of college must also provide a High School transcript, and graduate level students must provide a complete college/university transcript. You are responsible for including the following items with your application. Intent to Apply- Applicants must submit this online form on the IAA Foundation website prior to mailing application Official high school transcript Exception includes students with junior status or above enclosed mailed separate Official community college/university transcript enclosed mailed separate Personal Statement 1 essay (Section 5) Signatures/Personal Endorsements (Section 6) Activities template- Applicants must use the template provided on the IAA Foundation website Any additional essays required (check guidelines) APPLICATIONS AND ALL SUPPORTING DOCUMENTS MUST BE POSTMARKED ON OR BEFORE FEBRUARY 1, 2015 NO EXCEPTIONS PLEASE NOTE: INCOMPLETE APPLICATIONS ARE RENDERED INELIGIBLE. NO HANDWRITTEN APPLICATIONS OR ACTIVITIES TEMPLATES NO STAPLES OR DOUBLE SIDED DOCUMENTS MAIL TO: IAA Foundation I 1701 Towanda Ave I Bloomington, IL Direct questions to Susan Moore, IAA Foundation Director (309) smoore@ilfb.org

4 2015 SCHOLARSHIP APPLICATION HS Trans COL Trans Personal Stmt Activities Temp App# Office Use Only NO HANDWRITTEN APPLICATIONS WILL BE ACCEPTED NO STAPLES, ONE SIDED ONLY, PLEASE SECTION 1. GENERAL INFORMATION Date Name Last 4 Digits of SS Number Permanent Address City/State/Zip Phone ( ) Farm Bureau Membership # (if applicable) Home County Dairy co-op Membership # (if applicable) Collegiate Farm Bureau Member? For Prairie Farms Applicants: My parent is an employee of Prairie Farms Dairy My parent is a patron of Prairie Farms Dairy Parent name: Yes No High School Attended Community College attended to date (if applicable) Date when employment/patronage began: (mm/day/year) Year Graduated(ing) Year Graduated(ing) College/ University Attending for Fall 2015 Entering as a Freshman Sophomore Junior Senior Post-Graduate Major/Probable Major Supply code & description Minor or area of concentration (if applicable) How did you hear about this scholarship program? Parents' Names Parents' Occupations Are your parents actively engaged in farming? Yes No Comments While you may receive only one of the following awards, you may be eligible for more than one. Please check eligible selection(s) only. IAA Foundation General Scholarship Dorothy and Wilhelmine Ratermann Memorial Scholarship Robert F. Rouse Scholarship Greg Carney Scholarship Illinois Farm Bureau Legacy of Leadership Scholarship (separate essay required) Illinois Award Scholarship Heartland NAMA Steven A. Hammerschmidt Memorial Scholarship (separate essay required) William J. Kuhfuss Memorial Scholarship Dale E. Butz Scholarship Fletcher A. Gourley, Leonard Southwell and Roger Capps Memorial Scholarship Patron Employee Walter J. and Martha J. Wills Memorial Scholarship St Louis District Dairy Council Scholarship SECTION 2. ACADEMIC INFORMATION (Enclose official transcripts) High School GPA Check one: 4.0 scale 5.0 scale Other Composite ACT Score Current Overall GPA SAT Score If applicable

5 SECTION 3. ACADEMIC HONORS & AWARDS, ACTIVITIES, EXPERIENCE Use the expandable template provided on the IAA Foundation website. SECTION 4. FINANCIAL PLAN Please explain your financial plan and source of funding for your education. (Example: summer work, on-campus, work-study, savings from gifts, paid internships, etc.) Clearly convey the portion of the financing that is the student s responsibility. It is important that your financial information displays thoughtful reflection and planning. This information is held strictly confidential and will only be reviewed by the selection committee and Foundation Director. Please describe: Do you have a scholarship or tuition waiver for the school year? Yes No If yes, please complete the following: Name of Scholarship or Waiver Value Have you applied for any other type of financial assistance? Yes No If yes, please describe: Applicant s Marital Status: Single Married # Dependents Ages Name of spouse Occupation Number of brothers and/or sisters in college SECTION 5. PERSONAL STATEMENT On a separate sheet, please respond to the following essay topic (no more than 500 words). Describe your most meaningful achievement and how it relates to your field of study and your future goals. Has your family background played a role in your decision?

6 SECTION 6. PERSONAL ENDORSEMENTS *Optional, up to 10 points Select up to four individuals (other than immediate family) to review and endorse your application for an IAA Foundation Scholarship. Endorsement from your home county Farm Bureau Manager is worth 4 points. I have reviewed this individual s application for an IAA Foundation Scholarship. From my personal knowledge and experience, I endorse this individual as a viable candidate to receive a scholarship. Signature Relationship Signature Relationship Signature Relationship Signature Relationship I hereby certify that to the best of my knowledge, the above information is correct and complete. Student's signature Parent/Guardian's signature Date Date IMPORTANT: APPLICATION MUST BE SIGNED BY BOTH THE APPLICANT AND A PARENT OR GUARDIAN. COMPLETED APPLICATIONS MUST BE MAILED AND POSTMARKED ON OR BEFORE FEBRUARY 1, It is your responsibility to make sure that all supporting documents are received at the IAA Foundation office before the postmark deadline. Missing documents will render your application incomplete, and therefore ineligible. CONSENT AND RELEASE: For good and valuable consideration, the receipt of which is hereby acknowledged, I, the undersigned, for myself, my heirs, executors, administrators and assigns do hereby consent to the use of: 1. My name 2. The attached testimonial or statement (initialed by me) in whole or part; 3. Photographs, motion pictures, sketches, drawings, likenesses or other reproduction of myself and of my real and personal property and personal effects, in whole or in part, either alone or in conjunction with items (1) and (2) above; Exclusively by Illinois Farm Bureau or its agent, acting solely in behalf of Illinois Farm Bureau, or successors or assigns of Illinois Farm Bureau for any purpose whatever, including (without limiting the generality of the foregoing), any advertising, trade, commercial or art purpose and use in any publication or other advertising media without limitation or reservation. (The undersigned is of full legal age. If under 21 years of age, signature of parent or legal guardian is required and should be designated as such.) I consent to the release I do not consent to the release Consent has no influence on scholarship judging or award decisions Signature Date Parent/Guardian s Signature (if a minor) Date

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