Application must be postmarked by Monday, Feb. 12, 2018 and sent to: 1530 Shumate Drive Bartow, FL (863)

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2018 Badcock Home Furniture & More Scholarship Application ***This application is only for students qualifying for a Badcock Scholarship who do not live in Polk County. Polk County residents should use the online application at www.polkeducationfoundation.org. These awards are administered by the Polk Education Foundation. Application must be postmarked by Monday, Feb. 12, 2018 and sent to: 1530 Shumate Drive Bartow, FL 33830 (863) 534-0519 ALL APPLICATION PACKS MUST INCLUDE: Completed application - You will print and complete the six pages of this application, get both signatures and attach all the required items listed below. Please secure all items with one paperclip. Picture of yourself (headshot) with your name and school written on the back A copy of your transcript Parent s income information one of either: 2017 W-2(s), 2017 income tax report, 2016-17 FAFSA report or SAR Type or print entire application neatly in black ink. Name School School Counselor and their phone number with area code Your Mailing address City, ZIP Phone

Email address Weighted GPA ACT score SAT score Are you on track to graduate at the end of the school year 2017? Yes or no Mother s Name Employment Father s Name Employment # people living in your home # of family members attending college including you Your past and Present Employment History Current # and type of volunteer hours Selected college or institution Have you been accepted? Intended college major List all other scholarships or financial aid for which you have applied and/or received other than those on this form. Award Name, Amount per year, and if it is received, denied or pending.

Please read the criteria of the seven scholarships listed below, and check the one(s) for which you are eligible. **To apply for the Wogan S. Badcock, Sr. and the William Knox Pou, Sr. Scholarships, the student, your parent, guardian or grandparent must be an employee of a Badcock department or store. Please list below your relative s name, their relation to you, their department code or the store number where they work, and the city and state that they work in. Evelyn Clark Badcock Scholarship GPA: 3.00 SAT/ACT: report Number awarded: 1 Scholarship overview: Student must attend an accredited college or university and study Education. Must demonstrate financial need and academic achievement. Describe community service in essay. Mitchell "Mike" P. Stiles Scholarship GPA: 3.00 SAT/ACT: report Number awarded: 1 Scholarship overview: Student must attend an accredited college or university and study Business, Public Relations or Politicial Science. Report community service type and hours in general essay. Demonstrate financial need and academic achievment. W.S. Badcock Career Education Scholarship Scholarship type: Career/Vocational GPA: 2.50 SAT/ACT: n/a Number awarded: Varying, not to exceed 5 Scholarship amount: $500 Distribution of funds: 1-time payment Scholarship overview: Student must plan to attend an accredited career/technical/vocational center. Must demonstrate financial need and academic achievement. Describe community service in essay. W.S. Badcock Academic Scholarship GPA: 3.50 SAT/ACT: 1210/28 Number awarded: Varying, not to exceed 4 Scholarship amount: $500 Distribution of funds: 1-time payment Scholarship overview: Report community service in general essay. Demonstrate financial need and academic achievement. ----------------------------------

Wogan Stanhope Badcock, Jr. Scholarship GPA: 3.00 SAT/ACT: 1210/28 Number awarded: 1 Scholarship overview: Student must plan to study Business. Report community service in general essay. Demonstrate academic achievement. ---------------------------------- Wogan Stanhope Badcock, Sr. Scholarship GPA: 3.00 SAT/ACT: report Number awarded: 1 Scholarship overview: Student must plan to study Business. Student s parent/guardian/grandparent must be employed by W.S.Badcock Corp. Must include employee information below. Must demonstrate financial need and academic achievement. Describe community service in general essay. Employee Name Relation to you (applicant) Department code or Store number City, State Zip William Knox Pou, Sr. Scholarship GPA: 3.00 SAT/ACT: n/a Number awarded: 1 Scholarship overview: Student must plan to study Business or Science. Must demonstrate financial need and academic achievement. Student s parent/guardian/grandparent or other relative must be employed by W.S. Badcock Corp. Must include employee information below. Employee Name Relation to you (applicant) Department code or Store number City, State Zip

Essay please type or computer generate Use this essay to provide information requested by each individual scholarship; personal financial need information, college and career plans, and any other information you feel would help in the selection process. Things like medical problems, divorce, and special family situations could all be considered when awarding scholarships. Most scholarships will be chosen solely on the information contained in this essay, so be specific and state your need clearly. Honors, awards, clubs, volunteer time, leadership roles and extra curricular activities may be included in your essay; however, do not send certificates, resumes or other documents as they are discarded and not considered. You may use the front side of one additional sheet of an 8.5x11 paper if needed for the essay. Minimum type size 10 point.

SCHOLARSHIP STATEMENT I understand that: (a) if my application is incomplete or does not contain all items from the required list, my application will not be considered, acknowledged or returned, (b) many scholarships will be decided based solely on the essay, (c those other than Polk Education Foundation staff may review my application for the selection process, (d) only those chosen to be interviewed will be notified of interview date/time, (e) if requested, I must attend an interview or be disqualified, (f) only the recipients of the scholarships will be notified by graduation. I further understand and agree that if I am chosen as a recipient: (a) I will attend the Senior Awards program at my high school to receive the award(s), (b) I will send a thank you note to the sponsor(s) of my scholarship(s) and a copy of the same thank you note to the Polk Education Foundation, (c) my scholarship check will not be released until my College Information Sheet AND a copy of my thank you note has been received by the Foundation office, (d) the Foundation may use my name and photo to publicize my award without any further compensation, (e) if I change colleges, it is my responsibility to request that the balance of funds be transferred back to the Polk Education Foundation to be reissued to the college I will be attending. I will notify the Polk Education Foundation of this in writing, (f) all monies received from a one-time award must be used within five years of my graduation. Any money remaining after that time will revert back to the Polk Education Foundation, (g) all scholarship checks will be sent on/about July 1 for Fall enrollment IF the above mentioned paperwork is returned to the Polk Education Foundation. Student s Signature Date Parent s Signature Parent s Printed Name