Culver's Family Restaurant

Scholarship Application
Culver Franchising System, Inc.
1240 Water Street
Prairie du Sac, WI 53578
608-643-7980 Sauk City, WI Middleton, WI Powell, OH
Spring Green, WI Rockwall, TX , Romeoville, IL
Richland Center, WI Baraboo, WI Taylor, MI

Due Date: June 1, 2011, CfSi Office

Dear Student:
We welcome your application for a Culver's® Family Restaurant scholarship. Scholarships in the amounts of
$500-$1000 will be awarded for the upcoming academic year.

To qualify you should:

1. Be a team member with Culver’s or the Blue Spoon for at least one year, as of June 1, 2011.
2. Have worked a minimum of 500 hours over the past year.
3. Have a grade point average of 2.5 or above.
4. Be enrolled (at least 12 credits) in a technical or college program in the fall of 2011.
(This scholarship applies to the 2011-12 school year.)

The following documents constitute a complete application:

1. Document A: The student scholarship application to be completed by the student.
2. Document B: The general manager’s confidential recommendation - to be completed and mailed to CfSi, or
given to the student in a sealed envelope.
3. Student’s transcript of grades - to be obtained by student.
4. A senior picture or current photograph. To be used for promotional purposes.

Instructions to the Student:

1. Please type or print clearly; neatness counts with the Selection Committee.
2. Give specific and complete answers to all questions. Do not answer questions using the letters N/A (not
applicable).
3. Check your student application carefully. Be sure all required information is given and the application is properly
signed. Unsigned applications will be disqualified.
4. IT IS THE APPLICANT’S RESPONSIBILITY TO SEE THAT ALL REQUIRED DOCUMENTS ARE RECEIVED IN
THE CFSI OFFICE (1240 WATER STREET, PRAIRIE DU SAC, WI 53578) NO LATER THAN June 1, 2011.

Recipients of scholarships for the upcoming academic year will be announced by August 1, 2011. Checks
will be distributed directly to your learning institution after Labor Day. Thank you for your cooperation in
completing this application, and good luck in your future career goals. There are incredible opportunities
waiting for you.
Document A: Student Application
Culver's Family Restaurant
Scholarship Application

Due Date - June 1, 2011, CfSi Office

Section I: Personal Information and Interests

Last Name: _________________________________ First: ________________________ Middle Initial: _______

Permanent Address: _________________________________________________________________________

City/State/Zip: ________________________________________________ Telephone: ____________________

E-mail: ____________________________________________________________________________________

I currently attend:(circle) High School Tech College College/University Not Attending/Enrolled

Name of present school: __________________________________City/State/Zip: ________________________

Next fall I will be attending (name of school): ______________________________________________________

School Address/City/State/Zip: _________________________________________________________________

I will be in my:(circle) 1st year 2nd year 3rd year 4th year 5th year

The area of study I’m interested in: ______________________________________________________________

__________________________________________________________________________________________

Restaurant where currently employed: ___________________________________________________________

General Manager’s Name: ____________________________________________________________________

My interest/hobbies are: ______________________________________________________________________

List any academic honors you have received: _____________________________________________________

__________________________________________________________________________________________

Name school or community organizations you have been involved with along with any leadership positions you
have held:
__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________
Document A: Student Application, Continued

Section II: Aspirations/Contributions

By answering each of the following questions in about 250 words, please tell us why you are deserving of
this scholarship. (Please attach a separate statement.)

1. What have you learned and contributed to Culver’s or the Blue Spoon which makes you a good
candidate for this scholarship?

2. Tell about a school, volunteer or community service project you have participated in to bring about
positive change.

3. What are your educational goals and how do you intend to reach them?

DUE DATE - June 1, 2011

Mail completed application to:

Culver Franchising System, Inc.
1240 Water Street
Prairie du Sac, WI 53578

Required Signature
To the best of my knowledge, I have provided Culver’s with full information concerning all questions on the
application. I agree to report any factors which could affect consideration of my application. I understand that failure
to provide true and complete information could mean withdrawal of scholarship monies. Upon submission, my name,
photo, or likeness can be used for promotional purposes.

Applicant’s Signature __________________________________________ Date _____________________

Congratulations! You have completed the first step toward financial reward and industry recognition.
Please take a few moments to increase the likelihood of being selected as an award recipient by
proofreading your application. The careful completion of your application will reflect your professionalism.
Document B: General Manager’s Confidential Recommendation
Culver’s Family Restaurant
Scholarship Application

Due Date - June 1, 2011, CfSi Office

Dear General Manager:

In order for your team member to be eligible for a scholarship, please complete all questions and type or print your
answers clearly. Your responses will be kept confidential.

Your Name: ____________________________________________ Today’s Date: _____________________________

Restaurant Location: _____________________________________ Telephone: _______________________________

I recommend ________________________________________________ for a Culver’s Family Restaurant Scholarship.

Team Member Name

I. EMPLOYMENT HISTORY AND PERFORMANCE OF YOUR TEAM MEMBER

In order for your team member to be eligible for a Family Restaurant Scholarship, he/she must have been employed with
Culver's or the Blue Spoon for at least one year, as of June 1, 2011, having worked at least 500 hours within a year.

Date of Employment: ____________________________ Number of hours worked over the past year: ______________

Current Position and Responsibilities:__________________________________________________________________

________________________________________________________________________________________________

II. PERSONAL PERFORMANCE

Rank each quality on a scale of 1 to 5, as it applies to this team member, with 5 being the highest ranking.
Check the box that applies.

5 = Excellent 4 = Good 3 = Average 2 = Below Average 1 = Poor

5 4 3 2 1 Comments
Guest Awareness

Attitude & Work Ethic

Organization

Leadership Potential

Initiative & Motivation

Responsibility/Dependability

Maturity/Professionalism

Resourcefulness & Creativity

Capacity for Learning

Quality of Work

Relationship With Others

Career Commitment

Communication
Document B: General Manager’s Confidential Recommendation, continued
III. PERSONAL/PROFESSIONAL RECOMMENDATION
Please respond to the following question on a separate sheet.

What specifically has this person contributed to your workforce that qualifies him/her for a scholarship
recommendation?
(Include examples of the student providing exceptional guest service, interacting with fellow team members and
his/her leadership potential.)

This confidential form is required in order for your team member to be eligible for a Culver’s Family
Restaurant Scholarship. Please take a few moments to increase the likelihood of him/her being
selected as an award recipient by proofreading your recommendation. It will reflect on the overall
appearance and quality of the student application.

DUE DATE - June 1, 2011, CfSi OFFICE

General Manager’s Signature _________________________________ Date _________________

PLEASE COMPLETE AND MAIL TO:

Culver Franchising System, Inc.
1240 Water Street
Prairie du Sac, WI 53578

OR

Return to student in a sealed envelope