AK STEEL – “SEBALD” SELF-RELIANCE AWARD

1 Page 1 of 9 AK STEEL sebald SELF-RELIANCE AWARD A fund of the Foundation for the Tri-State Community, Inc. ELIGIBILITY Any graduating member of the Senior Class of the following schools: Paul G. Blazer High School; Boyd County High School; Fairview High School; Rose Hill Christian School; Russell High School HOW TO APPLY Complete the application. Return to your Counselor/Advisor by March 6, 2015. An official copy of your transcript is required to be submitted with your application.

2 In addition, applicant must ensure that one (1) counselor/advisor rating form and two (2) classroom teacher rating forms are received by the counselor/advisor on or before the due date. These forms are to be submitted by the Counselor/Advisor with the application. Applications that are submitted without these three forms will be considered incomplete and will not be considered by the Selection Committee. WHY WAS THE AWARD ESTABLISHED? The sebald SELF-RELIANCE AWARD was established to reward a neglected talent of a student using his/her time wisely.

3 This means not only in school, but also in church activities, in the community, at home or in the workplace. This is not a scholarship. The student need not be at the top of his/her class scholastically nor must he/she be going to college to win the cash AWARD . Please be advised that this is a taxable AWARD . Recipients will receive a 1099 from the Foundation at year-end for tax purposes. HOW WILL RECIPIENTS BE CHOSEN? From the application, judges will examine school, church, community, home and job activities.

4 On this basis, the judges will select and interview possible AWARD recipients. awards will be granted on the basis of: Work for Pay Work without Pay Resourcefulness with Time and Money Activities Character Selection Committee will be comprised of members of the Ashland Breakfast Kiwanis and a representative of the Foundation for the Tri-State Community, Inc. Ashland Breakf ast Kiw anis Please place a copy of your senior cut here Page 2 of 9 CONFIDENTIAL APPLICATION FOR THE AK STEEL self reliance AWARD A fund of the Foundation for the Tri-State Community, Inc.

5 MALE FEMALE Name:_____ BIRTH DATE:_____ (First/Middle/Last) ADDRESS:_____ (Current mailing address) PARENTS/GUARDIANS:_____ TELEPHONE:_____ (Home) (Alternate Number) NUMBER OF BROTHERS/SISTERS:_____ NUMBER OF INDIVIDUALS AT HOME:_____ DOES ANYONE DEPEND ON YOU FOR FINANCIAL SUPPORT? _____ HIGH SCHOOLS ATTENDED: 10th Grade: _____ 11th Grade: _____ 12th Grade: _____ PRESENT HOMEROOM TEACHER: _____ Ashland Breakfast Kiwanis Page 3 of 9 EMPLOYMENT HISTORY List all jobs, whether part-time or full-time, which you have worked.

6 Begin with your most current position and continue back to your 9th grade year. It is vital that you include names and phone numbers as each will be contacted for verification purposes. Employer/Company With/ Without Pay Phone Number Type of Work # Hours per Week Start Date End Date NOTE: If you need extra space, please attach an extra sheet of paper. COMMUNITY ACTIVITIES List activities, clubs or organizations other than church or school, in which you have participated, including any positions held.

7 _____ CHURCH ACTIVITIES Church Attended: _____ Pastor: _____ Telephone Number: _____ Activities:_____ Page 4 of 9 SCHOOL ACTIVITIES List activities, clubs, organizations or sports in which you have participated, including any positions held. 10th Grade: _____ 11th Grade: _____ 12th Grade: _____ ACADEMIC SCHEDULE 11th Grade 12th Grade Vocational or College YOUR PLANS FOR THE FUTURE Page 5 of 9 What are your plans upon completion of high school? How have you prepared to accomplish them?

8 _____ Career Goals? _____ ADDITIONAL INFORMATION List any other reasons why you think that you are eligible for a SELF-RELIANCE AWARD . _____ The above statements and information in this application are true to the best of my knowledge. I hereby give the W. W. sebald Selection Committee my permission to investigate and confirm the contents of this application. Your signature: _____ Date: _____ Page 6 of 9 PERSONAL LETTER Please explain on this page why you should be chosen for this AWARD .

9 USE YOUR OWN WORDS AND HANDWRITING. Page 7 of 9 CONFIDENTIAL AK STEEL sebald SELF-RELIANCE AWARD A fund of the Foundation for the Tri-State Community, Inc. CANDIDATE RATING FORM Applicant must ensure that one (1) counselor/advisor rating form and two (2) classroom teacher rating forms are received by the counselor/advisor on or before March 6, 2015. These forms are to be submitted by the Counselor/Advisor with the application. Applications that are submitted without these three forms will be considered incomplete and will not be considered by the Selection Committee.

10 Counselor/Advisor Rating Form Name:_____ Teacher Rating Form Name:_____ STUDENT:_____ Please circle one rating for each characteristic. Key to Rating System 4 = Above Average 3 = Average 2 = Below Average Dependability and Thoroughness 4 3 2 Cultural Refinement 4 3 2 Leadership Skills 4 3 2 Industriousness 4 3 2 Mental Alertness 4 3 2 Conduct in Class, Halls, School 4 3 2 Personal Grooming and Appearance 4 3 2 Ability to get along with others 4 3 2 Time Management Skills 4 3 2 Works up to Ability 4 3 2 Communication Skills 4 3 2 Comments: _____ NOTE.