This form is to be used for scholarships offered through the Caring Community Foundation for graduating seniors. Please refer to the list of scholarships available for your school and course of study and then mark the scholarships you are applying for. Please fill out the form as completely as possible. Applications are due by March 31, 2021.

Blue Valley Randolph
Jennifer K. Moore Nursing (BSN) Scholarship $500 Renewable

Centralia and Frankfort

CHCS Healthcare Scholarship $500
Walter Byers Scholarship $1000

Holton High and Jackson Heights
CHCS Healthcare Scholarship $500
Walter Byers Scholarship $1000

CHCS Healthcare Scholarship $500Ron R. Lee and Richard J. Rosenfield Scholar-Athlete Scholarship $1000The CHD#1 Auxiliary Scholarship $500 RenewableBruce Wayne Stallard Scholarship $1200 RenewableJennifer K. Moore Nursing (BSN) Scholarship $500 Renewable
Onaga Alumni Scholarship $500
Walter Byers Scholarship $1000

Rock Creek
CHCS Healthcare Scholarship $500
The CHD#1 Auxiliary Scholarship $500 Renewable
Jennifer K. Moore Nursing (BSN) Scholarship $500 Renewable
Walter Byers Scholarship $1000
Westmoreland (Brill) Scholarship $500
Krouse Family Agricultural Scholarship $500
Wayne Dunafon Memorial Scholarship $500

St. Marys
St. Marys Alumni Scholarship $500
CHCS Healthcare Scholarship $500
Walter Byers Scholarship $1000

Contact Information

Name (required)
Date of Application (required)
Phone (required)
Email (required)
Address (required)
City (required)
State (required)
Zip (required)

Parent / Guardian Information

Name(s) (required)
Phone (required)
Email (required)

School Information

ACT (composite) or SAT Verbal/Math
Class Rank
Number in Class
Name of School

Family Information

List family members, their relationship to applicant and ages of the minors. Please indicate any that are also in a post secondary program. Address financial needs.

School Activities

List the athletic activities, clubs and organizations you have been involved in over the past 4 years. Also note any offices held and what years. (e.g. Kays-9th, 10th, 11th, secretary in 11th).

Special Honors/Awards

List any awards or special recognition here (e.g. a 1 rating in band senior year.)

Community Service

List any service done in the local community outside of school hours. May have been in conjunction with a school organization.

Other Interests

List areas of special interest, hobbies or talents.

Work Experience

List any regular jobs and approximate time of employment. (e.g., worked 15 hours/week at Smith's Gas Station for 3 summer months of 2019). Then list general non-regular jobs and approximate length of work. (e.g. babysitting for neighbors for 2 years.)

After Graduation Plans

List the technical school, community college, college or university you plan to attend. List several if undecided.

Intended area of study. List in order of current preference.


Include two (2) letters of recommendation with this application, or deliver to your school counselor. Letters from relatives are not acceptable and not more than one letter should be from a faculty member. Please name your recommendations and their relationship to you below.


(200-300 words) What qualities do you possess that would make you the best recipient of this scholarship? Please attach your essay below.

Understanding of and Agreement to Scholarship Terms

By signing below, I understand that my application and any material submitted will be reviewed by the scholarship committee which may include community members.
Signature of Applicant (required)
Date (required)
Signature of Parent/Guardian (required)
Date (required)

Document Upload

Upload your Essay (required) PDF format required.
Upload your Letter(s) of Recommendation (required) PDF format required.

You should receive a confirmation email within 24 hours of submitting your application. If you do not receive this confirmation, please contact Susie Kufahl at