McCullough-Delaney & Butler Funeral Home Scholarship In memory of John and Genelle McCullough, the Butler Family of Organizations is honored to offer the McCullough- Delaney & Butler Funeral Home Scholarship in the amount of $1,000.00 to a graduating New Berlin High School senior who meets the qualifications outlined below. To be eligible for consideration for this scholarship, a graduating New Berlin senior will: Have a 3.0 GPA or better Enroll as a full-time student in a o 4-year College Program o Associate Degree Program o Vocational Program resulting in a licensure or certification Demonstrate financial need Document on-going volunteer activity with one or more local service organizations Provide letters of recommendation from a o Teacher whose class you have been in o One or more Community Organizations you have worked with Submit a completed application to the New Berlin High School Principal no later than April 1 st. The McCullough Legacy John and Genelle McCullough were the well-respected owners of the McCullough Funeral Home, serving New Berlin and the surrounding community for 39 years, where both served as licensed professional funeral directors. John was a businessman, gentleman, and avid Pretzel fan, attending as many high school sporting events as he could. He served the New Berlin Community in many capacities: Mayor, Village Board, School Board, Business Men s Organization, Men s Community Club, and West Sangamon American Legion Post 743, among others. Genelle was a lady and a true professional. She had an impressive business career in St. Louis and Jacksonville before moving to New Berlin, where she was active in the New Berlin Women s Club, West Sangamon American Legion Post 743, and a tireless member of Island Grove United Methodist Church. In addition, Genelle was a correspondent for the Jacksonville Journal Courier and the Springfield State Journal-Register for many years. The Butler Family of Organizations officially became a part of the New Berlin area communities when it assumed ownership of the McCullough-Delaney Funeral Home in 2005. The Butler Family is committed to continue the legacy of excellent service the McCullough and Delaney families provided the New Berlin area communities. We are honored to be a member of the New Berlin business community and continue to support many local organizations and charities.
McCullough Delaney & Butler Funeral Home Scholarship 1. Personal Information Full name of applicant Home telephone number Email address Home address City State Zip Number of years lived in New Berlin Date of birth 2. Family Information Mother s name Occupation Street address City, State Father s name Occupation Street address City, State Name and ages of siblings/other dependents. Indicate what school(s) they attend. Name Age School or college/years attended Relationship 3. Education a. Name all schools you have attended. List the school you are presently attending first. b. What course of study would you like to pursue? c. What is your career goal?
d. What college/technical school would you most like to attend? Please explain your reason. e. What college/technical school have you applied to for admission? Please indicate acceptance status. f. List scholarships, grants or loans for which you have applied, and check the ones you plan to use. Indicate funding amount you will receive. Name Amount Plan to use 4. Academic, athletic, service, and extra-curricular activities. Use additional pages if needed. a. List academic awards, achievements and dates. b. List participation in athletic activities. c. List participation in community service, including length of service, hours per week/month and specific activities for each organization.
d. List participation in extra-curricular activities. 5. Employment History List jobs you have held in the last three years. Employer Position Dates Hours per week Salary 6. Financial Need Summary Complete this section regarding Taxable Income of your parent(s) for the current year. Name of person(s) employed Family Size Taxable income listed on Line 43 of the Federal Tax Form 1040 or Line 38 of the Federal Tax Form 1040A Family Size Taxable Income $ Describe any special circumstances such as medical conditions, disabilities, etc. that may affect your ability to pay for your college tuition. Use additional pages if necessary. 7. Transcript History This section is to be completed by your principal or guidance counselor. Attach a certified transcript of the student s high school record to this sheet. Ranking in senior class: of GPA: on a scale
Best Combined SAT Score: Verbal Writing Math Best ACT Score: Date Score Signature of principal or guidance counselor 8. Signature I state the above information is accurate to the best of my knowledge. Signature of Applicant Date