Application
Name
____________________________________________
Address:
____________________________________________
City, State and Zip Code:
____________________________________________
Telephone:
_______________________ E-mail ____________________@_________
High School
________________________________ Date of Birth __________________
Father or Guardian
____________________________ Occupation: ____________________________
Mother or Guardian ____________________________ Occupation:
___________________________
How many people are
dependent on your parents? _________
Give ages of brothers? __________________________ Sisters?
______________________________
How many brothers and/or sisters will be in college
next year? __________
What college(s)?
___________________________________________________________________
What work for pay have you done during the last year?
_____________________________________
_________________________________________________________________________________
What work for pay do you plan to do this coming
summer? __________________________________
_________________________________________________________________________________
What is your college preference?
_______________________________________________________
What do you plan as a college major?
____________________________________________________
Have you been accepted at
the college of your choice? _________
Have you applied to other colleges/universities? _________ If so where?
_______________________
_________________________________________________________________________________
What is the approximate cost of attending the college
of your choice during next year?
________________________________________________________________________________
Have you applied for financial assistance through the college’s student aid
office and/or through filing a
need analysis form (FAF or FFS)? _______ so, which?
____________________________________
Name other scholarships for which you have applied?
______________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
List your extra-curricular activities and honors in High School and in the
community.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Parent’s or Guardian’s Endorsement:
I, (Signature of Parent or
Guardian)_____________________________, hereby declare
that, to the best
of my knowledge, the foregoing statements are complete and accurate; and I
approve
(Name of Applicant)_____________________________’s application for this
scholarship.
Signature of Applicant:
_________________________________ Date:
________________
Application must be signed & returned by
Contact Max Rodden
at 476-1001 for additional information.