MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01CB6958.20FCFB80" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01CB6958.20FCFB80 Content-Location: file:///C:/AAE3E902/AppFormWeb.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"

IAN ADAMS VAN HEYDE MEMORIAL SCHOLARSHIP FUND

APPLICATION FOR SCHOLARSHIP GRANT—2010

 

Section I         = Personal Information of Applicant

 

Last Name        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;          First Name      &nb= sp;            =             &nb= sp;         Middle Name or Initial             &= nbsp;           &nbs= p;            &= nbsp;          

 

Permanent Street A= ddress        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;

 

City        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            State        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       Zip Code      &nb= sp;            =             &nb= sp;            =

 

Phone Number (        )        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;           Fax Number (if any)    &nbs= p;            &= nbsp;              &= nbsp;           &nbs= p;            &= nbsp;          

 

E-mail address if = any        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =                   &= nbsp;           &nbs= p;            &= nbsp;          

 

Age            =             &nb= sp;            =             &nb= sp;   Date of Birth      = ;            &n= bsp;            = ;            &n= bsp;        Social Security Number           &= nbsp;           &nbs= p;            &= nbsp;          

            =   

 

Sex   Female      Male            =             &nb= sp;            =       U.S. Citizen      =             &nb= sp;        Yes            =        No

            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =    Permanent Resident      = ;       Yes            =        No

 

Section II       Sc= hool Information

 

Name of High Schoo= l or Career Center Attended for Culinary Arts Program            =             &nb= sp;            =                    &= nbsp;           &nbs= p;            &= nbsp;          

 

Address of School<= span style=3D'mso-tab-count:10'>        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;          &= nbsp;           &nbs= p;            &= nbsp;          

 

City        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            State        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;          Zip Code      <= span style=3D'mso-tab-count:1'>        &= nbsp;     

 

Date Graduated, if applicable     &nb= sp;            =             &nb= sp;       Date Expected to Graduate if Currently Enrolled&= nbsp;            &= nbsp;           &nbs= p;            &= nbsp;          

 

Name of High School if Different     &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;           &= nbsp;           &nbs= p;            &= nbsp;          

 

NOTE:  Applicant must provide copy of high school transcript showing successful completion o= f at least one academic year in a Culinary Arts or Food Management Program before scholarship grant will be sent to post-secondary school.<= /b>

 

I plan to attend:   Proprietary School       Two Year College         Four Year College<= /span>

 

I have:   applied to and<= span style=3D'mso-spacerun:yes'>   gained acceptance to:=

 

School Name        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                   &= nbsp;           &nbs= p;            &= nbsp;          

 

Address        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =                 &= nbsp;           &nbs= p;            &= nbsp;          

 

City        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            State        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       Zip Code      &nb= sp;            =             &nb= sp;            =

 

Financial Aid Offi= ce Phone Number      &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;                  &= nbsp;           &nbs= p;            &= nbsp;          

 

Anticipated Major<= span style=3D'mso-tab-count:10'>        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;          &= nbsp;           &nbs= p;            &= nbsp;          

 

I plan to receive:        &= nbsp;           &nbs= p;            &= nbsp;             Two Year Associates Degree        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;    Four Year Bachelor’s De= gree

 

 

Section III      Food Management and Culinary Arts Related Courses

 

Please list all resta= urant, Culinary Arts and Hospitality related courses you have successfully completed.

 

Course        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =      Completion Date

            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;             =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;        

 

Section IV      Restaura= nt and Hospitality Work Experience

 

Please list all work experience you have had in t= he restaurant and hospitality field.

 

Name        &= nbsp;           Ad= dress and Phone Number of Employer  &nb= sp;            =             &nb= sp;     Position Held      &nb= sp;            =            Dates Employed

            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;             =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;   

 

Section V        Awards and Competitions

 

Please list all Culin= ary Arts or Food Management awards received or competitions participated in:

 

Name of Award or Competition   &n= bsp;            = ;            &n= bsp;            = ;         Dates        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;    Award or Certificate Received

            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;             =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                 &= nbsp;           &nbs= p;            &= nbsp;          

 

Section VI      Essay Question—(Maximum Word Count:  250)

 

On a separate sheet o= f paper identified with the name of applicant, please type, double space, your resp= onse to the following question and attach to the application:<= /p>

 

How will the award of= an Ian Adams Van Heyde Memorial Scholarship assist you in pursuing your career in = the Culinary Arts?

 

VERIFICATION

 

      = ;         I hereby certify to the Scholarship Awards Committee of the Ian Adams Van Hey= de Memorial Scholarship Fund that the information contained in this application (including the accompanying transcript and letters of recommendation) is complete and accurate and that the response to the Essay Question is the applicant’s own work product.

 

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;       , 2010 &nbs= p;            &= nbsp;           &nbs= p;               &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;     

      = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;           Sig= nature of Applicant

 

      = ;         Applications with all required attachments must be postmarked or e-mailed on or before M= ay 3, 2010 to:

 

Stephen and Nan Van Heyde

259 Lenappe Drive

Columbus,  Ohio  43214<= /span>

or

svanheyde@bakerlaw.com

 

100855010.6

------=_NextPart_01CB6958.20FCFB80 Content-Location: file:///C:/AAE3E902/AppFormWeb_files/header.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"

(continued)

(continue)

PAGE=   - 2 -

 

PAGE  - 2 -<= span style=3D'font-size:10.0pt'>

 

 

 

------=_NextPart_01CB6958.20FCFB80 Content-Location: file:///C:/AAE3E902/AppFormWeb_files/filelist.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01CB6958.20FCFB80--