RLCF Scholarship Application

The Rend Lake College Foundation is offering a variety of scholarships available for the 2016-2017 academic year. These scholarships have been provided by local businesses and individuals assisting Rend Lake College in maintaining its margin of excellence. Awards are based upon scholarship criteria and will be divided between the fall and spring semesters. Submit the following data with a copy of your transcript and at least one letter of recommendation to:

Rend Lake College Foundation
468 N. Ken Gray Parkway, Ina
Illinois 62846.


First Name *:  
Middle Name:  
Last Name *:  
Social Security Number or WarriorTag*:  
Date of Birth *:  
Address *:  
City *:  
State *:  
Zip *:  
County *:  
Primary Phone:  
Secondary Phone:  
Email Address:  
Gender *:
Marital Status:
# of Dependent Children:    
Annual family income *:  
Number of family members living in your household *:  
Parent's Names: (for dependent students only)  
Parent's Address: (for dependent students only)  
Parent's Employer: (for dependent students only)  
Parent Income Comments: (for dependent students only)
Are You Currently Employed? *:
Employer Info (Name/City/State):  
High School *:  
High School City/State *:  
Current GPA *:   Out of:  
High School Class Rank:   Out of:  
Year of High School Graduation *:  
A.C.T. Composite Score *:  
If you do not have an ACT Score, please enter zero
Type of Student *:
Expected College Major *:
Why have you chosen this field of study? *:
Expected RLC Graduation Year *:  
Are You a signed RLC Athlete? *:

If so which sport?  
List any Extracurricular High School/RLC activities:
List any Community Service:
List any Awards and Honors:
Please write a brief statement indicating your educational and career goals *:
Explain your financial need for a scholarship or any special circumstances affecting your family income *:
This portion of the application is optional and provides additional information that aids the RLC Foundation in the selection process. You are encouraged, but not required, to respond to each question.
Are you or were you in the top 3rd of your graduating class?:
Did you attend Belle Rive, Ewing, Rome or Waltonville Grade School?:
If yes, please list:
Are you a Mount Vernon STRIVE participant?
When will you start classes at Rend Lake College?

Are you planning to enroll in any Botany or Horticulture classes?
Do you plan to pursue a career in the medical field?
If yes, please specify career ambitions:
Have you attended an RLC Automotive Car Show?

Are you a member of RLC Phi Theta Kappa?
Are you participating in the RLC STARS program?
Do you have any siblings attending college during the 2016-2017 academic year?
Are you an RLC Student Employee?
If yes, please list supervisor(s)
Are you a current or former employee of McDonald's in Benton, Herrin, Johnston City, McLeansboro or West Frankfort?
Are you or your parents customers of Hamilton County Telephone Co-Op & Its Subsidiaries?
If yes, provide customer name, address and home phone:
Are you or your parents customers of SouthEastern Electric Co-Op, Inc.?
If yes, provide customer name, address and home phone:
Do you have a parent or spouse who is employed at Continental Tire the Americas, Inc.?
If yes, provide name & relation.
Are you a dependent or affiliate of an active or retired employee of Knight Hawk Coal Co.?
If yes, please list:
Are you an affiliate or have immediate family affiliated with the Polk Lodge No. 137 - McLeansboro?

If yes, please list:
Are you receiving Financial Aid?(Pell,MAP,etc.)
Are you receiving a High Achiever, Presidential, or Tuition Waiver from RLC?
Are you receiving any other scholarships for 2016-2017?
If yes, please list:
* - Required field  
CONSENT TO RELEASE INFORMATION By clicking Submit, I certify that the information provided on this application is true and accurate. I am a student or planning on becoming a student at Rend Lake College for the 2016-2017 academic year. By clicking below, I grant permission to Rend Lake College to release my academic transcript, class schedule, fee statement, and financial aid information to the Rend Lake College Foundation, scholarship committees and donors. I also grant permission to the Rend Lake College Foundation to release the information provided on this application including supplemental materials to the scholarship committees and donors if I am being considered for their scholarship award. I release to Rend Lake College and the Rend Lake College Foundation the right to use my name and picture for publications, reports, and press releases. If you have questions
regarding the scholarship application or scholarships please contact Caitlin Keele, Scholarship Coordinator at 618-437-5321 ext. 1213 or by email
[email protected]