Fillable October 7, 2019 Dr. Virginia M. Wagner (Taylor University)

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October 7, 2019 Dr. Virginia M. Wagner (Taylor University)

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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 ________
______________________________________________________ City ____________________ State ________
Year in school
next
semester (check): 1, 2, 3, 4, 5 _________________
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 ____
__________________ ___________________________ _______ Granted ____ Pending ____
__________________ ___________________________ _______ 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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October 7, 2019 Dr. Virginia M. Wagner (Taylor University)

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Completed 29 July 2020

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