Fill - Free fillable October 7, 2019 Dr. Virginia M. Wagner PDF form

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Dr. Virginia M. Wagner

October 7, 2019

Dear Counselor or Advisor,

I am pleased to announce the Virginia M. Wagner Educational Award opportunity for women,

presented by Soroptimist International of Indianapolis Metro. Soroptimist is an international volunteer

organization for business and professional women who work to improve the lives of women and girls, in

local communities and throughout the world. I hope you will encourage participation from women at

your college or university to apply for this award. The Virginia M. Wagner Educational Award is unique

to the Soroptimist Midwestern Region, and therefore only women attending schools in or who are from

the states of Illinois, Indiana, Kentucky, Michigan, Ohio and Wisconsin are eligible to apply.

Some facts about the Virginia M. Wagner Educational Award include:

• It is a financial award for women seeking a bachelors, masters or doctorate degree.

• Applicants taking on-line courses or seeking degrees from on-line universities ARE eligible.

• Information about the award is available on our club’s website at

www.soroptimistindymetro.org.

• At the Indy Metro club level, $1,000 will be awarded for first place and $500 for second place.

• Winning applicants go on to compete at the District level ($1,000), and those winners at the

Region level ($2,500).

Applicants need only visit our club’s website—www.soroptimistindymetro.org—and download the

application to get started!

Applications are due by January 15, 2020. Applications and all supporting documents need to be

sent electronically to virginiawagnerSIIndyMetro@gmail.com. Please don’t hesitate to contact me

with any questions!

Sincerely,

Jennifer Burchett

Club Chairperson, Virginia M. Wagner Educational Award

Soroptimist International of Indianapolis Metro

virginiawagnerSIIndyMetro@gmail.com

!

Virginia M. Wagner Educational Award

Fact Sheet

1)

Each Soroptimist International of the Americans Region use to select and support a

specific region project. In 1972, the Midwestern Region established as their Region

Project an award given annually to a woman who is attending college/university to

further her education in order to provide advancement.

At the 2004 Spring Conference, the name was changed from the “Region Award Project”

to the “Virginia M. Wagner Educational Award,” in honor of Dr. Virginia M. Wagner,

MWR Governor 1982-1984, to commemorate her interest in higher education for

women.

2)

Only those women residing in the states of Illinois, Indiana, Kentucky, Michigan, Ohio,

and Wisconsin may apply.

3)

Women may apply for only one Soroptimist award, and to only one club, per calendar

year.

4)

Judging at the club, district, and region level is conducted by three non-Soroptimists

who utilize a standardized scoring sheet for each application.

5)

Judging is based on effort toward education (35%), general impression (20%),

scholarship (15%), extra-curricular activities (15%), and need (15%). Therefore, this

award is particularly relevant for the woman in a bachelors, masters, or doctoral program

of study.

6)

The winner of the “Virginia M. Wagner Educational Award” will be awarded $2,500.00

and each of the remaining 3 district winners will receive $1,000.00 each at Spring

Conference.

7)

There are three primary differences between the Federation’s Live Your Dream Award

(LYD) and the Region’s Virginia M. Wagner Educational Award:

• The LYD Award is weighted toward need.

• The LYD Award can be given to a woman who is enrolled in a non-college or

technical training program.

• The Virginia M. Wagner Educational Award is for Midwestern Region

only. Federation (SIA) does not provide any funding for the award.

Soroptimist International Midwestern Region 2019-2020

1

Soroptimist International of the Americas Midwestern Region

Virginia M. Wagner Educational Award Application 2020

Type or print all information except signatures. Deadline to club: January 15, 2020

Applicant must be a high school graduate or GED holder currently enrolled in a university or college.

APPLICANT

Last Name ___________________________________ First _________________________ Middle Initial _____

DATA

Permanent Home

Mailing Address ____________________________________________________________ Apartment # _______

City __________________________State ________ Zip Code _________ Home Phone (____)_______________

Work Phone (____)_____________ E-mail Address _______________________________________________

Marital Status _______________ Maiden Name (if applicable) _______________Date of Birth ____________

How did you hear about this grant? School ___ Friend ___ Internet ___ Other ___ (specify) ______________

FAMILY

Independent adults, complete Part A. Dependent adults, complete Part B.

MAKE-UP

A. Spouse Name ___________________________Occupation ________________________________

Children Number ________ Ages _________________

B. Mother Name ___________________________Occupation ________________________________

Father Name ___________________________Occupation ________________________________

Other Dependent Siblings Number ________ Ages _________________

HIGH

School Name __________________________________________High School Graduation Date____________

SCHOOL

DATA

City ________________________________ State __________ Telephone ( )_________________________

POST -

Name of post-secondary school in which you are enrolled. Use official school names, please do not abbreviate.

SECONDARY

SCHOOL

DATA

______________________________________________________ City ____________________ State ________

Year in school

Undergraduate Study ________Graduate Study _______ Post Graduate Study_______

Major ___________________________________________ Enrollment status: Part-time _____ Full-time ____

Number of semesters or credits remaining before graduation: Semester(s) # _________Credits # ________

Expected graduation date: ____________ Degree sought: Bachelor _____ Masters _____ Doctoral _____

Describe previous degree(s) earned (if any)_______________________________________________________

2

GOALS

Attach a typewritten essay, limited to two pages, covering the following topics. Put your name on each page.

1. Why did you choose to enter this profession?

2. What is your ultimate goal in this profession?

3. How would this grant affect your educational plans?

4. What efforts have you and your family made toward obtaining your degree?

5. What unusual family or personal circumstances have affected your achievement in school, work

experience, or your participation in school and community activities?

TRANSCRIPT

An official transcript of grades for the past academic year

must

be sent with this application.

Photocopies are

acceptable.

On-line transcripts

are not

acceptable.

ACTIVITIES,

List all community or school activities in which you have participated without pay during the

past four

OFFICES, years

(e.g.

work at school or children’s school, civic or cultural organizations). Note special awards, honors,

HONORS

and offices held.

AWARDS

Activities/Offices/Honors/Awards Year(s)

______________________________________________________________________________ ___________

WORK

Describe your work experience during the

past four years

(if homemaker, please indicate). Indicate dates of

EXPERIENCE

employment for each job and approximate

number of hours worked

each week. List monthly amounts

earned.

Employer/Position From Mo/Yr To Mo/Yr Hours per week

Earned monthly

_________________________________ __________ __________ __________ ______________

FINANCIAL To be considered for the award, this information must be filled out completely.

What do you estimate your total expenses to be: This Year _______________ Next Year _______________

How much of this amount is for: Books ___________ Room & Board ___________ Tuition ______________

Other (specify) ___________________________

If you anticipate higher expenses next year, please explain.

_____________________________________________________________________________________________

Amount you can provide from your earnings __________Amount your spouse/parents can provide _______

From prior year IRS Form 1040: Adjusted Gross Income ______________Federal Tax Paid______________

3

OTHER

List the name and annual amount of any grants, awards, or scholarships you have been awarded for the

FINANCIAL

school year.

AID

Name of Award School where award will be used Amount Check One

__________________ ___________________________ _______ Granted ____ Pending ____

4

REFERENCES

List three references (not relatives), one of whom is a professor at the school you attend and attach letters

of reference.

Name Occupation Address and Zip code

Phone Number

_____________________________ Professor _________________________ ___________________

_________________________

_____________________________ ________ _________________________ ___________________

_________________________

_____________________________ ________ _________________________ ___________________

_________________________

• I certify that all information provided in this application is complete and accurate to the best of my knowledge. I will notify

the designated club to which I have submitted this application if there are any changes.

• I understand that this award is not a scholarship and is therefore taxable for citizens of the United States. (For more

information, consult IRS publication 520.)

• I certify that this is the only application I have made this year for a Virginia M. Wagner Educational Award or for a Live Your

Dream Award from this or any other Soroptimist club.

• I understand that my application becomes the property of Soroptimist International of the Americas, Midwestern Region. The

application will be considered confidential, unless the applicant grants Soroptimist written permission to release personal

information for the purpose of publicizing the Soroptimist Virginia M. Wagner Educational Award. By typing or signing your

name below, you adhere to the above requirements.

This certifies that I am a resident of Ohio, Illinois, Indiana, Wisconsin, Michigan, or Kentucky.

Applicant Signature ________________________________________________ Date _____________________

I have read and agree to the release of my information to the media including, but not limited to, newspapers, magazines, or

other print or electronic media.

Accept Decline

Applicant Signature ________________________________________________ Date _____________________

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