Service.
By providing one specific example, describe how your service to others has impacted
the school or community.
______________________________________________________________
Last name,
First
Middle
Bi-County Cooperative Foundation
2008 Foundation Scholarships/Awards/Grants
The
Foundation Scholarships
The Foundation Scholarships are Bi-County’s most prestigious scholarship awards, recognizing academic, leadership and service achievement as well as special personal qualities that are described under "Selection Criteria." Up to 6 Scholarships from $250.00 to $500.00 will be awarded to students entering the field of special education and programs that promote the inclusion of students in the community and school environments. Up to 5 Scholarships from $250.00 to $500.00 will be awarded to students with special needs entering into a school of higher learning or a vocational program after High School. One Scholarship up to $250.00 will be awarded to a student with Autism Spectrum Disorder who wishes to enter into a school of higher learning or a vocational program after High School and one scholarship up to $250.00 will be awarded to a family of a student with Autism Spectrum Disorder who would like to educate themselves further about Autism Spectrum Disorders. Scholarships will all be awarded in the Spring of each year.
Achievement Awards
Up to 10 Achievement Awards in the amount of $50.00 will be awarded to a teacher, student, community member, who makes a significant contribution in the life of a person with a disability. Recipients may or may not have special needs and eligibility will not be restricted based on such. To receive scholarships, awards and/or mini grants recipients will be selected based on promoting the mission of our Foundation. Achievement awards will be collected throughout school year and given in Spring of each year.
The Foundation Mini Grants
Up to 20 Mini Grants up to $500.00 will be awarded to support the criteria outlined above and support the mission statement of Foundation. Recipients of mini grants will be chosen at regularly scheduled Board meeting by majority vote of Board Directors present. Mini Grant Forms will be distributed under separate cover upon request.
Eligibility
• Applicants for Bi-County Special Education Scholarship must apply for admission to a school of higher learning in the field of special education or be currently enrolled in a program that supports the goals of the Bi-County Cooperative Foundation. Applicants may also be eligible within the High School setting should they choose to use monies for a program within the High School setting that would enhance an activity to promote inclusion with regular education students. All applications must be submitted in typed format.
• To
be a competitive scholarship applicant, a cumulative GPA of 3.5 is the expected norm. Exceptions to this norms must be indicated on
your application, e.g., English is your second language; you have a learning disability;
you are a student over traditional age; there have been special circumstances. All
applications must be submitted in typed format.
• There are no restrictions to fields of age, financial need, or marital status.
Applicants for Bi-County Education Scholarship and Propheter Family Scholarship/Stipend must apply for admission to a school or higher learning or a vocational or trade program. Documentation of special needs must be submitted with application. If applicant under Propheter Family Stipend desires education for family members, a stipend form must be completed and submitted prior to January 15 of each year. All applications must be submitted in typed format.
Nominations for Achievement Awards can be made by a school counselor, teacher, family member, community member, person with special needs and will be given preference based on service and leadership that promotes the mission statement of the Bi-County Cooperative Foundation. Achievement Award nominations will be accepted through March 10 of each year. All applications must be submitted in typed format.
Selection
Criteria
• Students will be selected as finalists on the basis of their academic accomplishments, creative distinctions, extracurricular activities particularly in the field of special education and special recreation, letters of reference, and original written paragraph. Finalists may possibly be invited for an interview with members of the Selection Committee.
• Students who will contribute to the inclusion of community and academic life of children with special needs are identified by the committee, which looks for qualities such as intelligence, self-reliance, energy, imagination, originality, and concern for others. The scholarships are not only awarded to honor past achievements but also as investments in the future.
Monies used for Stipends will be reimbursed after attendance at an event and upon submission of receipts for event.
Application
Deadline
The
application for Scholarships together with all related documentation must be postmarked
no later than January 15, 2008 and sent to the Bi-County Cooperative Foundation
Scholarship Selection Committee. Notification of finalists will be in March, 2008.
Interviews, if deemed necessary, will be scheduled in January and/or February, 2008. You
may write or call if you have any questions. Phone: (630) 208-6750, Fax: (630) 208-4986,
or Email: marcp2@sbcglobal.net
Send your application to: Bi-County Cooperative Foundation Scholarship
Committee,
Please
type, make one copy of this application, and send both copies to the address above.
I wish to be considered for a Bi-County Cooperative Foundation Scholarship. I have read and agree to all conditions stipulated for candidates for Bi-County Cooperative Scholarships. I include in this application all required items. I have arranged that confidential letters of reference written on my behalf will be sent by their authors directly to the Bi-County Cooperative Foundation Scholarship Committee, postmarked no later than January15, 2008.
Signed: _________________________________________ Phone: __________________________
Mailing Address: _________________________________ Email: __________________________
City, State, Zip: __________________________________
Date: ___________________________________________
Scholarship Applying For:
Bi-County Special Education Scholarship ______ Bi-County Education Scholarship ______
Propheter Family Scholarship ______ Propheter Family Stipend ________ Achievement Award ________
Application for Mini-Grants
– please contact Drew Hoffman, CEO/Executive Director Bi-
APPLICATION FORM
Special Education Scholarship (For Regular Education
Students going into Special Education Field)
High School(s) attending and or attended: (Name, address and years attended): ________________________________________________________________________
________________________________________________________________________
High School(s) attended (name, address and year(s) attended): _______________________________________________________
______________________________________________________________________________________________
Cumulative GPA _________H. S. Class Rank ____ /_______
Intended Area of Study: _______________________________________________
Why do you
want to attend college and what are your goals and dreams for the future?
A. Select and rank your most important high school activities, dates of participation, awards received, and offices held (include student government, sports, school publications, arts, drama, debate, exchange programs, etc.).
High School
Activity
Dates Awards
Offices
B. List public service and community activities in which you have voluntarily participated without pay (include projects with community organizations, environmental protection and conservation efforts, work with religious organizations, candy striping, scouts, etc.). Do not repeat items listed previously.
Activity
Dates Number
of Weeks Actively Involved
C. List other awards, honors, and other forms of recognition you have received.
D. List important summer activities over the past three years.
Summer
Activity
Dates
IV. Written Statement. Respond to two of the following three writing prompts on a separate sheet of white paper. You must respond to number one and choose from either number two or three. Answers to both questions combined should total no more than one typed page. Your typed page should be double spaced, size twelve font, times new roman, and have one inch margins. If this format is not followed, you will not be considered for a scholarship.
Service.
By providing one specific example, describe how your service to others has impacted
the school or community.These paragraphs are an important part of your application and will weigh heavily in the selection process; therefore, prepare it well in advance of the deadline. It is advisable to be as specific as you can, using ample details. Proofread your essay very carefully. We recommend that your essay have a focus, and we strongly encourage originality.
Two
letters of recommendation, one from a high school teacher and one from another teacher,
counselor, administrator, or person who can objectively assess your abilities and your
character. Form letters or letters from friends and family have little value. Please ask
your references to address the following: (It is suggested that you make a copy
of this section and the "Selection Criteria" on the opposite page to give to
them.) Do not submit more than two letters.
LETTER OF REFERENCE
Applicant’s
Name: ________________________________________
Scholarship
Applying For: _________________________________
Your Name: _____________________________________________
1. How long and in what capacity have you known the applicant?
What is your position?
2. Describe the applicant's motivation and potential for academic success. Please be specific.
3. Describe the applicant's distinctive qualities or different characteristics that you have personally observed that make the applicant particularly qualified to receive a Bi-County Cooperative Foundation Scholarship.
APPLICATION FORM
Bi-County
Education Scholarship (Special Education Students) _____
Propheter
Family Scholarship (Student with Autism Spectrum Disorder) ______
Please check which Scholarship
Applying for
Name: _______________________
Address:
________________________________________________________
Telephone: __________________________Alternate: ____________________
Email:
___________________________________________________________
High School(s) attending and or attended: (Name, address and years attended): ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Intended Area of Study: _______________________________________________
Nature of Special Needs:
__________________________________
How have you learned to accommodate your needs in the classroom and in the community?
What assistance, adaptations and accommodations do you believe you will need to succeed in your course of study?
Why do you
want to attend college and what are your goals and dreams for the future?
A. Select and rank your most important high school activities, dates of participation, awards received, and offices held (include student government, sports, school publications, arts, drama, debate, exchange programs, etc.).
High School
Activity
Dates
Awards
Offices
B. List public service and community activities in which you have voluntarily participated without pay (include projects with community organizations, environmental protection and conservation efforts, work with religious organizations, candy striping, scouts, etc.). Do not repeat items listed previously.
Activity
Dates
Number of Weeks Actively Involved
C. List other awards, honors, and other forms of recognition you have received.
D. List important summer activities over the past three years.
Summer
Activity
Dates
Written Statement. Respond to two of the following three writing prompts on a separate sheet of white paper. You must respond to number one and choose from either number two or three. Answers to both questions combined should total no more than one typed page. Your typed page should be double spaced, size twelve font, times new roman, and have one inch margins. If this format is not followed, you will not be considered for a scholarship.
Service. By providing one specific example, describe how
your service to others has impacted the school or community.These paragraphs are an important part of your application and will weigh heavily in the selection process; therefore, prepare it well in advance of the deadline. It is advisable to be as specific as you can, using ample details. Proofread your essay very carefully. We recommend that your essay have a focus, and we strongly encourage originality.
Two letters of
recommendation, one from a high school teacher and one from another teacher, counselor,
administrator, or person who can objectively assess your abilities and your character.
Form letters or letters from friends and family have little value. Please ask your
references to address the following: (It is suggested that you make a copy of
this section and the "Selection Criteria" on the opposite page to give to them.)
Do not submit more than two letters.
Nomination for Achievement Award
Bi-County Cooperative Foundation
Name of
Person Nominated:
Address:
___________________________________
Telephone:
_________________________________
In 500
words or less please describe why you feel this person should be given an achievement
award and recognized by the Bi-County Cooperative Foundation for making a significant
difference in the life of a person with disabilities.
Your name:
________________________________
Address: _________________________________
Telephone: _________________________________
(Please
type and submit in duplicate to review team at: Bi-County
Cooperative Foundation Scholarship Committee,
Bi-County
Cooperative Foundation Propheter Family Consumer Stipend Form
Funds are to
enable people with developmental disabilities and their family members to attend
conferences of their choice that are directly related to autism spectrum disorder issues
Who can apply?
•
Resident who resides within the boundaries of Bi-County Cooperative Foundation areas.
• A
person with autism spectrum disorder.
• A
parent of a person with autism spectrum disorder.
• An
immediate family member of a person autism spectrum disorder.
• A
guardian/foster parent of a person with autism spectrum disorder.
How much can I
apply for?
• $250
per person per year
• $250
per family per year
•
Consumers are expected to participate in cost sharing and contribute 50% or more of the
total costs of the conference or to provide a reason why they need additional support.
What Can I
Apply For?
•
Conference must be directly related to autism spectrum disorders.
•
In-state or out-of state
How do I
apply?
• The
application form must be completed and returned to Bi-County Cooperative Foundation
Scholarship Committee,
brochure and a
completed registration form.
• The
application must be filled out in the person(s) name attending the conference and
hotel/motel information and rates should be included, if requesting.
• All
applications and conference registration forms must be received 30 days prior to the date
of the conference/workshop.
•
Conference or workshop topics must specifically relate to autism spectrum issues.
•
Stipends are not approved retroactively for previously attended conferences.
•
Conference Registration
• Child
Care
• Respite
Care
• Meals
•
Personal Attendant
• Hotel
•
Transportation
What can I use
these funds for?
Any Questions?
Call 815-622-0858
Where do I
apply?
Complete the
application form and mail or fax it to the following address. A completed copy of the
conference registration form and a copy of the conference brochure MUST be submitted with
the application.
Bi-County
Cooperative Foundation Propheter Family Stipend
Fax (24
hours): 1-630-208-4986
How do I learn
if I get a stipend?
•
Completed applications are reviewed by a review team committee to determine whether the
conference is related to a developmental disability issue, whether the applicant is
eligible for funds, and whether or not there are funds available
•
Applicants are notified in writing following the review team’s decision. Every effort
is made to ensure the stipends are received before the scheduled event.
• Please
do not call repeatedly to find out if your application has been approved. We will contact
you as soon as possible.
Requirements
of Stipend Fund Users:
• It is
the applicant’s responsibility to make sure that the original application form is
complete.
•
Applications are not considered completed until the conference brochure, conference
registration form, and total conference expense details are submitted.
•
Consumers are expected to contribute a minimum of 50% of the cost of attending a
conference or to provide a reason why they need additional support.
• Funds
must be used for the stated purposes.
• Unused
funds are returned so that more people with autism spectrum disorders can attend more
conferences.
•
Receipts are submitted for all expenses funded through the stipend.
• Any
individual, family, or organization that has not provided complete documentation of and
receipts for any stipend funds received is ineligible for further support until such
documentation
is provided.
• People
using stipends must complete and submit a post-conference evaluation form and are expected
to:
1. use the
information received through the conference attended to make a change in their life or to
share the information with others.
2. include on
the evaluation form what changes have been made or information shared after the
conference.
Any
Questions?
Call
708/206-
1930
Application
Form –
Date
Name
Address
City
Phone
E-Mail
Fill in the
blanks that apply (1-3) and answer #4:
1. I am a
person with an autism spectrum disorder.
2. My family
member (circle one: son, daughter, other) is a person with an autism spectrum disorder.
Family Member Name:
3. I am the
guardian/foster parent of a person with an autism spectrum disorder. Their disability is:
4. Describe
the living arrangement of the person of the autism spectrum disorder:
Names and date
of birth (DOB) of all family members attending the conference/workshop.
1.
DOB
3.
DOB
2.
DOB
4.
DOB
Name of
conference/workshop you want to attend:
Dates/
Location
Have you used
the Consumer Stipend Project before?
If so, when
For what conference?
Enter amount
of financial assistance needed for (maximum received is $250/person or $250/family):
Registration $
Child Care
$
Attendant $
Respite Care $
Hotel $
Meals $
Transportation
$
Total Costs $
50% of Total
Costs $
The following
statement must be signed to validate this request: I am requesting assistance from The
Bi-County Cooperative Foundation through funding to attend a
conference
that I would be unable to attend without this support. I promise to use the funds for the
stated purposes and to submit receipts for all expenditures funded through this stipend. I
will also complete a post-conference evaluation form.
Signature________________________________________________________________