Application Form

Reminder: If you begin the application process it must be completed to submit. It will not save your progress.

The Correctional Professionals Assistance Fund of Indiana

Applicants for the Correctional Professionals Assistance Fund of Indiana Scholarship Program must:

Complete all sections of the application. This application and all materials must be received by December 12, 2022.

Your name and address must be included in all attachments. The scholarship amounts shown below are annual amounts that are subject to change.

*Full-time study is defined as full-time enrollment for the entire upcoming academic year

*Please check the box (es) next to the scholarship(s) you are applying for. The available scholarships are:

Commissioner's scholarship ($7,500), Eugene Lasco Public Safety scholarship ($4,000), Rose Vaisvilas scholarship ($3,000 one available), Supplies scholarship ($2,000 -approximately eight available), Part-time student scholarship ($1,000 -approximately four available)

Section 1 - APPLICANT INFORMATION

Name

Cell/home Phone

Date of Birth

Permanent Address

Future Campus Address (if known)

Section 2 - Employee Relationship with the IDOC/Work Experience

A. If you are an employee of the Indiana Department of Correction, please indicate

B. If you are a dependent of an IDOC employee, indicate:

C. If you are an IDOC-placed employee of a vendor that holds a current contract for services

D. If you are a dependent of an IDOC placed employee of a vendor that holds a current contract for services with the IDOC, indicate

E. List and briefly describe any work experience:

Section 3 - Academic Information

Name of High School

Graduation/Completion Date

Grade Point Average

High School Rank

College/University/Vocational School:

Did you graduate?

Most recent College GPA

Graduation/Completion Date

Name of college/university/vocational school you plan to attend

Anticipated Major

Anticipated graduation/completion date

Section 4 - Activities, Awards and Honors, and Interests

A. List and briefly describe extracurricular or volunteer activities in which you have been involved.

B. List honors or academic awards you have received (e.g. scholarly activities, research, etc.):

Section 5 - Personal Statement: This should be a one-page, typed statement that describes your educational goals, and why you need financial assistance A. Make a brief summary of your plans as they relate to your educational and career objectives. B. If there is any unusual family or personal circumstances that you want considered as part of your application, please explain. C. How will you be financing your college education and how will a scholarship impact your plans? D. Is there any other information that we should know about you? This is your opportunity to include information that is not contained in other areas of the application. Please be specific.

Personal Statement Document

Section 6 - Essay * (not required for Supplies Scholarship or Part-Time Student Scholarship) * "What I hope to accomplish in my field of study to advance the quality of public service" Two Typewritten pages (81/2 x 11, double-spaced in drafting your essay, please give specific examples to clarify your ideas

Essay documents

Transcripts

Submitting your application Please submit the following to be considered for the award(S) Completed application form Copy of the student's official or unofficial transcript(s) of grades. Applicants for the Spring 2023 Scholarships will need to submit their current transcripts with their application. Scholarship winners will be required to provide an official transcript before awards can be distributed. If the applicant is beginning their first year of school, high school transcripts may be substituted. *(The essay is not required for Supplies Scholarship of Part-Time Student applicants) *

Acknowledgement of Signature

By checking this box, I authorize the release of all my applicant information including official transcripts to the Scholarship Review Team. I certify that the information provided by me is complete and accurate to the best of my knowledge. Falsification of any information may result in termination of any award. As an applicant, I agree to accept all decisions of the CPAFI Scholarship Committee as final. If I am selected as a recipient, I hereby give my permission to the Correctional Professionals Assistance Fund of Indiana board (CPAFI) to use my name, picture, narrative, and the fact that I was awarded a scholarship for promotional purposes. I hereby certify that the information contained in this application and enclosed documents are true, complete and correct to the best of my knowledge.

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