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Carl N. & Margaret Karcher Founders’

2015 Scholarship Program

THE PROGRAM

Carl Karcher Enterprises LLC has established a scholarship program to assist students who plan to continue education in college or vocational school programs. Scholarships are offered each year for full-time study at an accredited institution of the student’s choice.

This scholarship program is administered by Scholarship Management Services®, a division of Scholarship America®. Scholarship Management Services is the nation’s largest designer and manager of scholarship and tuition reimbursement programs for corporations, foundations, associations and individuals. Awards are granted without regard to race, color, creed, religion, sexual orientation, gender, disability or national origin.

ELIGIBILITY

Applicants to the Carl N. & Margaret Karcher Founders’ Scholarship Program must be -

Students, age 21 and under, who reside in Alaska, Arizona, California, Colorado, Hawaii, Idaho, Louisiana, Nevada, New Mexico, Oklahoma, Oregon, Texas, Utah or Washington.

High school seniors or graduates who plan to enroll for the first time in full-time undergraduate study at an accredited two-year or four-year college, university, or vocational-technical school for the entire upcoming academic year.

Employees, affiliates and franchisees of Carl Karcher Enterprises LLC, Scholarship America, affiliated agencies and their immediate families are not eligible to receive a scholarship pursuant to this program.

AWARDS

If selected as a recipient, the student will receive a $1,000 award. Up to sixty (60) awards will be granted each year. Awards will be granted in proportion to the applications processed for students who will be attending each of the above types of schools. Awards are not renewable.

Awards are for undergraduate study only.

APPLICATION

Interested students must complete the current year application and mail it along with a current, complete transcript of high school grades to Scholarship Management Services postmarked no later than February 15, 2015. Grade reports are not acceptable. Only the first 1,000 applications from students in eligible states will be acknowledged and considered for an award.

Applications with prior year dates will not be accepted.

Applicants are responsible for gathering and submitting all necessary information. Instructions for completing the Financial Data section of the application are included. Applications are evaluated on the information supplied; therefore, answer all questions as completely as possible. A résumé does not replace any part of the application. Incomplete applications will not be evaluated. All information received is considered confidential and is reviewed only by Scholarship Management Services.

SELECTION OF RECIPIENTS

Scholarship recipients are selected on the basis of academic record, demonstrated leadership and participation in school and community activities, honors, work experience, statement of goals and aspirations, unusual personal or family circumstances, financial need and an outside appraisal.

Instructions for Completing the Financial Section of the Application

The Financial Data section of the application should be completed by the applicant’s parent(s) or guardian. Information should be from a completed tax return or based on estimated information to be filed with the IRS.

1.State of Residence is the state where the parents reside and pay state income tax.

2.Adjusted Gross Income can be found on IRS FORM 1040 and is gross income reduced by specific adjustments allowed by law.

3.Total Federal Tax Paid includes the total amount of federal income tax to be paid as reported on IRS FORM 1040. This is not the amount withheld from employee’s paychecks. (The amount withheld should be adjusted by any refund or additional taxes due.) Do not report state income tax.

4.Total Income of parent(s) should be reported individually. Provide information for both natural parents, when possible. If the student resides with only one parent, financial information must be received from the parent who claims the child as a dependent for tax purposes. If a parent has remarried, the spouse’s information is required if the spouse is a legal guardian of the student, or claims the student as a dependent, or the student is included in the spouse’s benefit plan. If necessary, two Financial Data sections may be submitted by the student. A copy of the Financial Data section may be made in order for one to be completed by each parent.

5.Untaxed Income and Benefits include any other income or benefits not included in the adjusted gross income figure. Do not include untaxed contributions to retirement plans.

6.Medical and Dental Expenses include only those expenses not paid by insurance. Do not include premium payments.

7.Total Cash, Checking, Savings, Cash Value of Stocks, etc., include liquid assets that can be used for educational expenses. Do not include IRA, 401k, or other retirement plan funds.

8.Total number of family members living in the household and primarily supported by the reported income may include:

the applicant

the applicant’s parents

other children living in the household

dependent college students living away from home

other people who live in the household and receive more than half of their support from the parent’s reported income

9.Marital status is the current status of the person from whom the financial information is submitted.

10.Of the total number of family members on line 8, number of students attending college includes family members attending a two- or four-year college, university, or vocational-technical school at least half-time. Include the applicant in this number. Do not include parents.

NOTE: Any exceptions to providing financial information as instructed above must be submitted to Scholarship Management Services in writing.

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Carl N. & Margaret Karcher Founders’

2015 Scholarship Program

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Sending a resumé does not replace any part of this application. If space provided in any section is inadequate, you may continue on additional sheets. Attachments must follow the same format. DO NOT repeat information already reported on the application form. Your name, address and name of this scholarship program should be included on all attachments.

(A clear explanation of the school’s grading scale must also be submitted.)

APPLICATION The student is responsible for submitting all materials to Scholarship Management Services on time. Incomplete applications will not be

CHECKLIST evaluated. This application becomes complete and valid only when all of the following materials have been received:

CERTIFICATION Scholarship Management Services has the sole responsibility for selecting recipients based on criteria as set forth in the program’s description. This application becomes the property of Scholarship Management Services. (It is recommended you keep a copy for your files.)

I acknowledge decisions are final. I certify I meet eligibility requirements of the program as described in the guidelines and the information provided is complete and accurate to the best of my knowledge. If requested, I will provide proof of information, including an official transcript of grades and a copy of my U.S. Income Tax Return. Falsification of information may result in termination of any award granted.