Fillable 2021 Scholarship Selection Committee Packet

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2021 Scholarship Selection Committee Packet

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Revised 12/2020

SCHOLARSHIP ADMINISTRATION

ACTION ITEMS FOR FUND ADVISORY COMMITTEES

Calendar Year 2021

This outline summarizes the actions that need to be taken with respect to scholarships awarded

by your Affiliated Fund:

For Affiliated Funds that DO NOT award any scholarships:

1. If your Affiliated Fund either does not have any scholarship accounts or does not intend

to select any scholarship recipients or make any scholarship payments from any of the

accounts within your affiliated fund during 2021, the chairperson or treasurer of your

Fund Advisory Committee (FAC) should sign the 2021 “Do Not Grant Scholarships

Response Form” (Attachment B) and return it to NCF.

2. Retain a signed copy of your Response and the rest of this information in the event that

your Affiliated Fund decides at a future date to award scholarships.

For Affiliated Funds that DO award scholarships:

1. Read all of the information in this packet. Remember that you cannot begin the

scholarship selection process until steps 1-3 are complete.

2. Submit your Scholarship Selection Committee Nomination Form (Attachment A) to NCF.

3. Wait to receive Scholarship Selection Committee notification of approval from NCF.

Please allow two weeks from the date submitted for NCF to review paperwork.

4. After receiving approval from NCF regarding your 2020 Scholarship Selection Committee

you may begin the scholarship selection process.

5. Familiarize yourself with the NCF Scholarship Policy & Guidelines (as amended

November 6, 2015) and follow all requirements.

6. Look at your quarterly fund report to find out how much is available to grant from each

of your endowed scholarship accounts. If you have questions, check with NCF.

Contact NCF if you have questions regarding this process

 Dena Beck, Affiliated Fund Development Coordinator…………………….……......308.832.7810

 KC Belitz, Chief Operating Officer……………………………………………………….………402.270.9119

 Steve Brewster, Affiliated Fund Development Coordinator………………….…….402.340.9937

 Janny Crotty, Affiliated Fund Development Coordinator……..……………..….…..402.770.3533

 Denise Garey, Affiliated Fund Development Coordinator……..…………….……..308.340.1942

 Jim Gustafson, Director of Advancement and Gift Planning……………...……....402.323.7341

 Jana Jensen, Affiliated Fund Development Coordinator …...….…………….….....308.588.6299

 Les Long, Controller ……………………………………………….………………………………....402.323.7346

 Emily Sulzle, Assistant Director of Gift Planning………………………………………….402.323.7329

 Kara Weander-Gaster, Affiliated Fund Development Coordinator……………...402.750.0600

SCHOLARSHIP SELECTION COMMITTEE NOMINATION FORM INSTRUCTIONS

For scholarship selections during the period:

January 1, 2021 through December 31, 2021

Refer to the Nebraska Community Foundation Scholarship Administration Policy as amended November 6, 2015

for additional information regarding the process for putting a Scholarship Selection Committee (SSC) in place for

your affiliated fund. The Pension Protection Act of 2006 mandated changes to the federal law governing certain

scholarship awards, so it is important to follow these procedures carefully.

“Affiliated Fund Name” is the name of your community foundation fund (e.g., Hometown Community

Foundation Fund); “Account within Affiliated Fund” is the name of the particular account (e.g., Jane Smith

Memorial Scholarship).

Attachment A, Page 2

Part I: Nominations for Scholarship Selection Committee (SSC):

• Nominations of SSC:

• Nominate at least four but no more than seven individuals for the Scholarship Selection Committee.

• At least one nominee must be a current member of the Fund Advisory Committee for your Affiliated Fund.

• Do not nominate any individuals who may have a relationship of the type set forth in the Scholarship

Policy with a person who may apply for a scholarship from the Fund. (see NCF Scholarship Policy &

Guidelines for definition of family member).

• Qualification of Nominees:

• Briefly state each individual’s qualifications to serve on the SSC. Examples would include educators

(principal, guidance counselor, teacher) and community or civic leaders.

Part II: List All Scholarships

• List each Scholarship that will be awarded by the nominated SSC.

• State the account within the Affiliated Fund from which scholarship is to be paid.

Part III: FAC Signoff

• The SSC Nomination Form must be completely filled out and signed by an officer (chairperson, vice chair,

treasurer, secretary) of the Fund Advisory Committee.

Part IV: Appointment:

• NCF will need to appoint the SSC for your affiliated fund every year, even if your Fund Advisory Committee

wants to nominate the same individuals who served on the SSC in the previous year.

• The scholarship grant process cannot begin until NCF has appointed your SSC for the current award cycle.

Attachment A, Page 3

 SSC Member Information Form:

• A copy of the information form must be completely filled out and signed by each SSC nominee.

• Keep copies of each information form for your committee records.

 Submit all pages to NCF in a single package by mail to P.O. Box 83107, Lincoln, NE 68501 or by fax to (402) 323-7349.

• Upon approval of the SSC, NCF will return a signed copy of Page 2 to the Fund Advisory Committee. Please

allow two weeks from submission for NCF to review all documents.

Attachment A

Page 1 of 4

 Once your SSC has been approved and you have received notification from NCF, you may begin the scholarship

selection process.

If you have questions or need assistance, please contact one of the following individuals at NCF:

• Dena Beck, Affiliated Fund Development Coordinator……………………….………..308.832.7801

• KC Belitz, Chief Operating Officer……………………………………………………….……….402.270.9119

• Steve Brewster, Affiliated Fund Development Coordinator…………………..…….402.340.9937

• Janny Crotty, Affiliated Fund Development Coordinator……………………………..402.770.3533

• Denise Garey, Affiliated Fund Development Coordinator…………………………….308.340.1942

• Jim Gustafson, Director of Advancement and Gift Planning……………..….…….. 402.323.7341

• Jana Jensen, Affiliated Fund Development Coordinator …...……………….….…...308.588.6299

• Les Long, Controller……………………………………………………………..………………….... 402.323.7346

• Emily Sulzle, Assistant Director of Gift Planning…………………………………………..402.323.7329

• Kara Weander-Gaster, Affiliated Fund Development Coordinator......………….402.750.0600

Attachment A

Page 2 of 4

SCHOLARSHIP SELECTION COMMITTEE NOMINATION FORM

For scholarship selections during the period:

January 1, 2021 through December 31, 2021

See SSC Member Information Form (Attachment A, Page 3) and Instructions (Attachment A, Page1)

Affiliated Fund Name:

Part I – Nominations for Scholarship Selection Committee (SSC)

Names of individuals nominated for SSC by Fund

Advisory Committee

Qualifications for serving on SSC

Part II – List all scholarships administered by the Affiliated Fund to be awarded by the above SSC

Name of Scholarship

Account within Affiliated Fund from which

scholarship is paid

Part III – Fund Advisory Committee Signoff

We recommend the nomination of the above-named individuals to serve on the Scholarship Selection Committee and state

that to the best of our knowledge the group of individuals nominated would not cause the SSC to be “donor controlled” with

respect to any of the scholarships to be administered by the SSC. All scholarships will be awarded in accordance with NCF’s

Scholarship Administration Policy.

Printed Name of Fund Advisory Committee Officer:

Signature:

Date:

Part IV – Appointment of SSC members by Nebraska Community Foundation (to be completed by NCF)

Nebraska Community Foundation hereby appoints members of the Scholarship Selection Committee for the above-named

affiliated fund as follows:

____ All individuals nominated by the FAC except for (list): ___________________________________________

Individuals appointed who were not nominated by the FAC (list): ________________________________________

Signature of Nebraska Community Foundation representative: __________________________ Date___________

Attachment A

Page 3 of 4

click to sign

signature

click to edit

click to sign

signature

click to edit

SCHOLARSHIP SELECTION COMMITTEE NOMINATION FORM

For scholarship selections during the period:

January 1, 2021 through December 31, 2021

Scholarship Selection Committee Member Information Form

(this page must be completed by each nominee for the Scholarship Selection Committee)

Name of Individual (please print):

Affiliated Fund Name:

Please review the list of scholarships on Attachment A, Page 2 of the Scholarship Selection Committee Nomination Form

and answer the following questions with respect to each scholarship. If the answer to any question is “yes”, please

provide the name of the scholarship from the list in Part II on page 2 and the pertinent facts at the bottom of this page.

Yes

Are you or a family member the donor for which the fund,

account or scholarship is named?

For any memorial scholarship, are you a family member of the individual being

memorialized?

For any scholarship named for an alumni or professional group, are you a

member of the group?

For any scholarship named for a corporation or other business, are you an

officer or employee of the corporation or other business?

Do you have a professional advisory relationship (e.g., attorney, accountant,

investment advisor) for the donor of any scholarship fund?

Do you have a family member who may be applying for a scholarship? If yes,

stop here; you may not serve on the Scholarship Selection Committee (See the

Scholarship Policy & Guidelines, as amended November 6, 2015, for a definition

of family member).

Additional information with respect to all “yes” answers:

Signature: ________________________________________

Attachment A

Page 4 of 4

click to sign

signature

click to edit

Attachment B

SCHOLARSHIP ADMINISTRATION RESPONSE FORM

FOR AFFILIATED FUNDS THAT DO NOT GRANT ANY SCHOLARSHIPS

For the Period

January 1, 2021 through December 31, 2021

Name of Affiliated Fund:

We have read the letter from the Nebraska Community Foundation dated January 2021 and the attached

information, and hereby confirm the following statements (check the line that applies):

 Our Affiliated Fund does not have any scholarship accounts;

 Our Affiliated Fund does not grant any scholarships out of our general account, endowment

account or any other account; and

 We will notify Nebraska Community Foundation in advance of beginning the selection process

if our Affiliated Fund decides to begin granting scholarships, so that we may implement the

scholarship administration policy and procedures then in place.

- - OR - -

 Our Affiliated Fund granted scholarships in the previous year but will not be selecting any

scholarship recipients or making any scholarship payments during 2021. Name of

scholarship(s): ____________________________________________________________

By: _________________________________ ________________________________

Signature Printed Name

Title: _______________________________

Return to NCF –

If by mail: Nebraska Community Foundation

Attn: Scholarship Administration

PO Box 83107

Lincoln, NE 68501-3107

If by fax: 402.323.7349

Attn: NCF Scholarship Administration

SCHOLARSHIP REPORTING FORM

Instructions: This form, along with a completed Disbursement Request Form, should be submitted at

the time you want the scholarship payment to be made. This form must be filled out completely. The

Selection Committee Chair must sign and date the form before submitting to the Nebraska Community

Foundation.

To comply with IRS reporting requirements, the Nebraska Community Foundation requires a separate

reporting form for each scholarship awarded by your fund.

Name of Scholarship Fund: ______________________________________________________

Selection Committee Chair: ____________________________ Phone: ___________________

Names of Selection Committee: __________________ __________________

__________________ __________________

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Scholarship Recipient Name: ____________________________________________________

Phone: __________________________

Student ID _________________ or Social Security No.______________________________

(only if Student ID Number not known)

Residence Address: ________________________________________ City: _______________

State: ______ Zip: _______________ Award Amount:____________

College/University___________________________________________

Mailing Address:____________________________________________

Phone: ________________ Email: _______________________________________________

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

How was the scholarship recipient selected?

______________________________________________________________________________

By checking the box, the Selection Committee Chair certifies that no Scholarship Selection Committee

member is a family member (as defined in the Scholarship Policy & Guidelines) of the scholarship recipient.

Contact NCF before awarding this scholarship if there is a family relationship between a Scholarship Selection

Committee member and a proposed scholarship recipient.

Selection Committee Chair:________________________________ Date: _______________

(signature)

Apply To:

Fall semester only

Spring semester only

Split equally Fall/Spr.

Other_____________

Please sign and return this form with a completed Disbursement Request form to: Nebraska Community Foundation

P. O. Box 83107 | Lincoln NE 68501 | 402.323.7330 | Fax 402.323.7349

Revised 12/2020

P.O.BOX83107|Lincoln,NE68501‐3107|402.323.7330



 Revised05/2019



DISBURSEMENTREQUESTFORM



  

(Fundname)     (Accountname)



Payto:

Nameofthepayeeforthecheckand

addresstowhichthecheckistobe

mailed

CharitablePurposeofpayment:

(i.e.:Grant,projectexpenseincludingidentificationofproject,meeting

expense,postage,suppliesorotherexpensecategory)

Amountofpayment

Pleaselisteachpayment

separately.

Includesalestax.





 





 





 





 



PleaseattachORIGINALinvoice,receiptorotherdocumentationforthispayment.

Youmustincludevendorinvoiceswithdetails;notstatements.



Disbursementrequestover$1,500forcommunityfundsor$5,000fororganizationalfundsrequiretwosignatures.



Phone:

Signature(s)ofperson(s)authorizedbytheFundAdvisoryCommitteetorequestdisbursements

SubmissionDate:



 Thedisbursementmustbeforcharitablepurposesandtoanallowablepayee.Ifyouhavequestions,pleasecontactour

AccountingStaffbeforesubmittingatinfo@nebcommfound.orgor402.323.7330.

 Ifyouwishtohaveachecksenttoyourfundadvisorycommitteeforaspecialpresentation,pleasenotethatclearlyonthe

form;otherwise,wewillmailthecheckdirectlytothepayee.

 DisbursementRequestsreceivedbyMondaywithallnecessarydocumentationandsignatureswillbepaidby

Fridayofthe

sameweek.

 WerecommendthatyoukeepaphotocopyofyourcompletedDisbursementRequestforfuturereference.



Thisformmaybephotocopied.ItisalsoavailableontheNCFwebsiteatwww.nebcommfound.org

ForInternalUseOnly

CkDate  Inv.#



Acct.Code  



Description  



Acct.Code  



Description  



Acct.Code  



Description  



Total$  1099



P.O.BOX83107|Lincoln,NE68501‐3107|402.323.7330



SCHOLARSHIPPOLICY&GUIDELINES

AdoptedbytheNebraskaCommunityFoundationBoardofDirectors

February7,2007

AsAmendedNovember6,2015



I. Purpose

ThepurposeofthisScholarshipPolicy&Guidelines(“Policy”)istoguideNebraskaCommunity

FoundationstaffandaffiliatedfundadvisorycommitteemembersandScholarshipSelection

Committeemembersintherequirementsfor

awardingscholarshipsincompliancewithInternal

RevenueService(“IRS”)rules.ThisPolicyalsoprovidesaconsistentprocessforawarding

scholarships.



II. Scope

ThisPolicyappliestoallgrantsforscholarshipsforanindividualtoattendaneducational

institutionwhentheaffiliatedfundadvisorycommitteeorasub‐committeethereofis

involved

intheselectionofscholarshiprecipients.



ThisPolicydoesnotapplytograntsfromanaffiliatedfundtoaneducationalinstitutionifthe

educationalinstitutionwillselectthescholarshiprecipient(s)inaccordance withitsownpoli cies

andproceduresforscholarships.



GrantstoindividualsforcharitablepurposesotherthanscholarshipsaresubjecttootherIRS

restrictionsandarenotcoveredbythisPolicy.NCFstaffshouldbeconsultedpriorto

consideringsuchgrantsto

individuals.



III. AwardingofScholarships

IRSrulesrequirethatscholarshipsbeawardedonan“objectiveandnondiscriminatorybasis”.

Thisrequiresthat(1)thepoolofeligiblerecipientsbelargeenoughtoconstitutea“charitable

class”,i.e.thatthereis“indefiniteness”astowhowillreceivethebenefit;(2)theselection



criteriamaynotresultindiscrimination inviolationofthelaw;and(3)thepersonsinvolvedin

selectingrecipientsarenotinapositiontobenefitdirectlyorindirectlyfromtheselection

process.Inordertomeettheserequirements,allaffiliatedfundsgrantingscholarshipsmust

complywiththefollowing:



GranteePool‐Ascholarshipfundoraccountmaydefinetheapplicantpoolbyacademic

standards,financialneed,residency,organizationorfieldofinterest,orgraduationfrom

aspecificNebraskahighschool(s),subjecttoNCFstaffapprovaloftheselectioncriteria.

Theaffiliatedfundshouldwidelypublicizetheavailabilityofscholarshipsinorderto

assureabroadapplicantpool.

 NondiscriminatorySelectionCriteria‐Usingreligion,race,

ethnicorigin,orgenderas

criteriaforascholarshipisnotallowedunlessapprovedinadvancebyNCF.

 ObjectivityofSelectionCommitteeMembers–Objectivitymeansthatthereisneithera

realnoraperceivedconflictofinterest.

o IndividualswhohaveafamilymemberservingontheScholarshipSelection

Committee(asdescribedbelow)arenoteligibletobeawardedascholarshipin

anycircumstance.

NCFScholarshipPolicy&Procedures|Page2of3

 AfamilymemberofanapplicantmaynotserveontheScholarship

SelectionCommitteeatall;itisnotsufficientforthefamilymemberto

excusehim/herselffromthediscussionoftherelatedapplicantorofa

particularscholarship.

 Familymembersincludetheindividual’s,parent,grandparent,great‐

grandparent,sibling,

spouse,child,grandchild,orgreat‐grandchild.

Step‐relativesinthesamerelationshipastheprecedingsentenceare

consideredfamilymembersforthispurpose.

o TheFundAdvisoryCommitteeshouldavoidnominatingindividualsfora

ScholarshipSelectionCommitteeeveniftheyarenotfamilymembersof

applicants,buthaveotherclose

relationshipswithascholarshipapplicantsuch

thatothersinthecommunitymightperceivealackofobjectivity.



Additionalrequirementsforawardingscholarshipsincludethefollowing:

 Scholarshipawardsmustbeforstudyataneducationalinstitution.Aneducational 

institutionisaschool,collegeoruniversitywhichmaintainsaregularfacultyand



curriculumandhasaregularlyenrolledbodyofstudentsinattendanceattheplace

whereitseducationalactivitiesareregularlycarriedon.

 NCFmustappointtheScholarshipSelectionCommitteepriortothebeginningofthe

scholarshipannouncement,appli cation,andselectionprocessinordertocomplywith

IRSrequirements.

 TheScholarshipSelectionCommitteeisresponsibleforwidelypublicizingtheavailability

ofscholarships,providingapplicationformstointerestedindividuals, evaluatingthe

applicationsbasedontheselectioncriteriaforeachscholarshipandselectingrecipients.



IV. ScholarshipSelection

Committees(“SSC”)

 Eachaffiliatedfundthatawardsoneormorescholarships shallhaveaScholarship

SelectionCommitteeconsistingoffourormoreindividuals,atleastoneofwhommust

beacurrentFundAdvisoryCommitteememberoftheaffiliatedfund.

 Toensurecompliancewiththerequirementsforscholarships

implementedbythe

federallawknownasthePensionProtectionActof2006(“PPA”),noSSCmaybe

controlledbyadonororpartiesrelatedtoadonorwithrespecttoanyofthe

scholarshipstobeawardedbytheSSC.“Donor” shallincludeanyonereasonably

determinedbyNCFtobe

coveredbytheprovisionsofthePPA,andshallinclude:

o Familymembersinthecaseofadonor‐advisedfundestablishedbysuchfamily.

PursuanttothePPA,thisdefinitionoffamilymemberisbroaderthanthatin

SectionIIIabove.

o Familymembersofadeceasedindividualin

thecaseofamemorialfund.

o Membersofaprofessionaloralumnigroupwhichsponsorsascholarship.

o Employeesofacorporationinthecaseofafundestablishedbythecorporation.

o ToensurethataSSCisnotcontrolledbyadonor,lessthan50%ofthe

membership

oftheSSCmaybeadonor,familyoremployeesofthedonor,or

individualswhoserveinanadvisorycapacitytothedonor,withrespecttoany

scholarshiptobeawardedbysuchSSC.

 Annually,onascheduletobedeterminedbyNCF,eachFund AdvisoryCommitteeshall

nominateindividualstoparticipateontheFund’sScholarshipSelectionCommittee.As

statedinSectionIIIabove,apersonwhowillhaveafamilymemberapplyfora

scholarshipmaynotserveontheSSC.

NCFScholarshipPolicy&Procedures|Page3of3

 Annually,NCFwillappoint theScholarshipSelectionCommitteeforeachaffiliatedfund.

WhilethenominationsmadebytheFundAdvisoryCommitteewillbetakeninto

account,NCFinitssolediscretionwillselecttheSSCmembers.



V. ScholarshipFundandAwardMinimums

 Aminimumof$25,000ininitialcontributions

isrequiredtoestablishascholarshipfund

oraccount.

 Theminimumamountofanannualscholarshipawardtoanyonerecipientis$500.NCF

encouragesaffiliatedfundstoawardscholarshipsinlargeramountsinrecognitionofthe

highcostofeducation.



VI.ProceduresforPaymentofScholarshipAwards



TheSSCmustcompleteaScholarshipReportingFormforeachscholarshipawarded.

 TheScholarshipReportingForm,alongwithaDisbursementRequestForm,shouldbe

submittedtoNCFwhenpaymentofthescholarshipistobemade.

 NCF,inaccordancewiththelaw,mustretainfinalresponsibilityforalldistributions.



Accordingly,NCFmaynotapproveaselectionmadebytheSSCiftheinformationonthe

ScholarshipReportingFormorotherinformationknowntoNCFindicatesthatthe

recipientwasnotselectedonanobjectiveandnondiscriminatorybasisortheawardis

notconsistentwiththepurposesofthefund

oraccountfromwhichthescholarshipisto

bepaid.

 Paymentwillbemadetotheeducationalinstitutionforthebenefitofthestudent,not

directlytothescholarshiprecipient.

 Scholarshipawardsof$2,000orlesswillbepaidtotheeducationalinstitutioninasingle

installment.Scholarshipsof

morethan$2,000maybepaidinoneortwoinstallmentsat

thediscretionofthefundadvisorycommittee.



ItisintendedthatthisPolicybeincompliancewithallIRSrequirementsforscholarshipawards.

Additionalproceduresbeyondthosestatedhereinmaybeputintoplaceinordertomeet

such

requirements.



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2021 Scholarship Selection Committee Packet

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