KRISTI ELAINE TEIGEN MEMORIAL SCHOLARSHIP

Jackson Community Foundation

Kristi Elaine Teigen Scholarship Committee

PO Box 91

Jackson, Minnesota 56143

CRITERIA FOR SCHOLARSHIPS

Scholarships will be granted by the Kristi Elaine Teigen Memorial Scholarship committee to
those individuals who have graduated from Jackson County Central who plan to continue
their education by attending a College, University, Community College or Technical College
as a full-time student. Scholarships will be made on the basis of academic ability, school
and community involvement, leadership, character and financial need.

We may award anywhere from 15-$1,000 scholarships to 1-$15,000 scholarship depending

on the number of awards the scholarship committee decides and depending on the number
of applicants who meet the requirements of the scholarship. Seniors who received an
award can renew up to four years if they apply and meet the requirements.

APPLICATION PROCEDURES

Incomplete applications may not be considered. Following are the application

requirements:

1. Eligible students must meet the requirements stated in the application. Higher math
and science requirement waived for two year programs.
2. High school seniors must submit an official transcript signed by a school official.
3. Two recommendations are required. One recommendation must be from an academic
teacher at Jackson County Central or college and the other reference from an
individual in the community. Recommendation forms should be sent directly to: Kristi
Elaine Teigen Memorial Scholarship c/o Jackson Community Foundation, PO Box 91,
 Jackson, Minnesota 56143. (It is the responsibility of the applicant to make sure the
references have been submitted by the due date.)
4. A copy of the first and second page of the parents IRS Form 1040 for 2015, 2016 and
2017 shall be submitted; as well as a copy of the parents’ personal financial statement
signed by the parents (sample enclosed or Finpack form).
5. All information will be held in strictest confidence.

All applications should be sent to:

Kristi Elaine Teigen Memorial Scholarship Fund

c/o Jackson Community Foundation

PO Box 91

Jackson, Minnesota 56143

Application deadline- April 20, 2018. Scholarship awards will be announced in late
May.

-In order to receive the funds for freshman year, the student must provide proof of
enrollment. In order to receive funds in successive years, the student must meet the
academic requirement of 3.25 or better gpa the previous semester at the post-secondary
institution. The applicant must be a full time student. Transcript and proof of enrollment
must be given to Kristi Elaine Teigen Memorial Scholarship Committee if renewing.

Questions, contact the Jackson Community Foundation at:

jacksoncommunityfoundation@gmail.com

or contact JCF Chair Dave Schmidt at 507-841-1808

 Previous Scholarship
Award Winners Only

You are to put all of your application

information together from your date of
graduation at Jackson County Central.
You will need to include only the most current year's tax information and a new
copy of your family's personal financial statement, signed by the parents. Also
provide a copy of your most recent college transcript along with the next
semester classes you are registering for.

You will still need to have 2 recommendation letters completed and sent to the
JCF address by those completing them. One is to be from an academic source (a
professor or mentor that you have taken a class with), and the other from
someone that you have built a report with after you began college (examples are:
employers, organization or club leaders, etc.). These letters are to be given to the
individual and mailed by them so that they are received by the deadline.
 KRISTI ELAINE TEIGEN MEMORIAL SCHOLARSHIP
APPLICATION

Applicant Information:

Name: ____________________________________________________________________________

Address: _________________________________________________________________________

Telephone contacts: ______________________________________________________________

Email Address:__________________________________________________

Desired Post-Secondary School: _______________________________________________

Major Field of Study: _______________________________________________

Minor Field of Study: _______________________________________________

___________Will live on Campus

___________Will live off Campus

___________Will commute

___________Will attend full-time______________Will attend part-time

For following please indicate the per semester amount:

Approximate Room and Board Costs: __________________________________________

Approximate Tuition Costs: __________________________________________

Approximate Books, etc. Costs: __________________________________________

Total Costs (per semester): __________________________________________

Applicant Requirements:

 Applicant must be a graduating senior at Jackson County Central High

School. Multi-year scholarships may be considered.
 Applicant must be enrolled in Post-Secondary Education at a College,
University, Community College or Technical College.
 Applicant must have a Cumulative GPA of 3.25 of a 4.0 scale in 9-12
grades.
 Applicant must have 4 years of Higher Math and Science (Waived for 2
year programs)
 Applicant should have Leadership Qualities.
 Applicant should be active in School, Community and Church
 Applicant should have work experience.
 Applicant must demonstrate financial need.
 Two recommendations are required. One recommendation must be
from an academic teacher at Jackson County Central or college and the
other reference from an individual in the community. The
recommendation forms should be sent directly to the Kristi Elaine
Teigen Committee by the person completing the form. Due
date: April 20, 2018 (It is the student’s responsibility to ensure
recommendation forms are sent in so that they are received in time.)

Transcript Information:

Please attach a High School Transcript showing Class Rank, Cumulative GPA, PSAT, SAT and
ACT scores.

*This transcript must be signed by a School Official.

Family Financial Information

Please provide three years of family Tax Returns (IRS 1040 Form) and the parents’current
personal financial statement (included with this application) signed by the parents of the
applicant and approved by their banker.
Personal Data (please list in chronological order):

 Please list on a separate sheet your activities for the past 4

years. (Leadership, Sports, Theatre, Arts, Music, Home, etc.) Indicate
awards and honors.
 Please list on a separate sheet your Community Activities (church,
clubs, volunteer activity, etc.) for the past 4 years.
 Please list on a separate sheet your work experience for the last 4
years.
 Submit no more than a one page narrative of yourself. Please
convince the Committee why we should award you a
scholarship. Include a statement of your plans as they relate to your
education, career objectives and future goals.
 Please list the names and amounts of any grants or scholarships that
you have been awarded for the coming school year.
 Committee may ask for a personal interview.
 Applicant shall complete and sign publicity agreement (attached).

**All application information is held in the strictest confidence.

 KRISTI ELAINE TEIGEN MEMORIAL SCHOLARSHIP

Report Summary to Include this Information in the Following Order:

1. Application form

2. One page narration on yourself

3. Official school transcript

4. School activities

5. Community activities

6. Work experience

7. Grants and scholarships (awarded thus far)

8. Family financial data (past 3 years of IRS Form 1040, and parent’s

personal financial statement)

9. Reference forms (one from a current educator and one general

reference) PLEASE CHECK WITH THOSE WRITING YOUR

REFERENCES TO SEE THAT THEY ARE RECEIVED BY THE

DEADLINE.

10. Publicity Agreement

 KRISTI ELAINE TEIGEN MEMORIAL SCHOLARSHIP

PUBLICITY AGREEMENT

I agree that if I am offered and accept an award from Kristi Elaine Teigen Memorial
Scholarship, the Jackson Community Foundation and/or the Southwest Initiative
Foundation may use my name, the name of my community, the name and address of my
school, the amount of the award, and the name of the post-secondary institution I will
attend (my “Recipient Information”) in press releases, public announcements, and other
fundraising or promotional materials in all media (including the Internet), to advance the
non-profit objectives of the Jackson Community Foundation and/or the Southwest
Initiative Foundation..

_______________________________________________________________________________

Applicant’s Signature/ Date

 KRISTI ELAINE TEIGEN MEMORIAL SCHOLARSHIP
REFERENCE FORM

____________________________has applied to the Kristi Elaine Teigen Memorial

Scholarship. Please complete and return this form as soon as possible. Deadline: April 20,
2018 to Kristi Elaine Teigen Memorial Scholarship Committee.

1. How long have you known the applicant and in what capacity?

2. How do you assess the character and personality of the applicant? Give attention to
achievement, judgment, maturity, reliability and leadership.

3. What is your evaluation of the applicant’s academic ability?

4. Are there unique factors that make the applicant especially worthy of receiving
financial support?

5. Additional comments. (Please us the back side of the page if additional space is
needed.)

_____________________(Attach additional pages as necessary)_____________________

Signed_____________________________________________Title_______________________________________________

Telephone Number_______________________________________________

Return to: Kristi Elaine Teigen Memorial Scholarship

c/o Jackson Community Foundation

PO Box 91

Jackson, Minnesota 56143