Polk County Farm Bureau P-4.01 Scholarship Application

Transcription

1 Polk County Farm Bureau P-4.01 Scholarship Application Instructions Applicant must complete the Polk County Farm Bureau Scholarship Application in full. An incomplete application will be considered ineligible. Example: Do not leave any item blank. If an attachment is used to complete an item, be sure to write, See attachment and correctly label your attachment with same corresponding number/section used in the application. See Page 4 thru page 5 for complete scholarship requirements. 1. Applicant s Name Last First Middle 2. Address 3. Telephone Cell Phone 4. Birthday Month Day Year 5. Name of Parents 6. Address 7. Parents Occupation 8. Other Siblings (Names & Ages) 9. Parents Income - Under $50K $50-75K $75-100K Over$100K 10. Applicants Financial From Savings % From Parents % From Others % Page 1 of 6

2 11. High School Graduated from 12. University, Junior College or Community College Selected For Next Year. A. B. 13. What Is Your Intended Major? 14. What Occupation are preparing for? 15. How Would You Describe Yourself? BE CERTAIN YOUR TRANSCRIPTS ARE INCLUDED WITH THIS APPLICATION: Transcripts are required of your last full academic year in school 16. Applicant s Overall GPA From High School University Jr. College Community College 17. What Will Be Your Academic Level for The Coming School Year. Freshman Sophomore Junior Senior 18. List School Activities, Citizenship And Scholastic Recognition, Awards And Honors. Page 2 of 6

3 19. List Involvement In Community Activities And Service. ( Please indicate the approximate number of annual hours spent per activity). 20. Describe your Three Top Leadership Experiences. 21. List Your Work Experience/Describe Your Job Responsibilities and Activities. 22. How Did You Learn Of This Scholarship. 23. Please Submit (By April 1) Three Letters Of Recommendation And List The Names, Addresses and Telephone Numbers Of Individuals Providing The Letters. A. B. C. 24. Write a brief description regarding your past agricultural experiences. Did you grow up on a farm? Have you worked on a farm? If the answer is yes to either question, how many acres are on the farm(s). What was raised on the farm? What kind of responsibilities did you have on the farm? 25. In your own handwriting, write a one, not more then two page paper, explaining how your course of study will impact Oregon Agriculture or Forestry. Page 3 of 6

4 Scholarship Requirements Applicant Eligibility: An Applicant must meet one of the following requirements: A. Applicant must have been a resident of Polk County during their high school years. B. Applicant must have attended high school in Polk County. C. Applicant or parents must be Polk County Farm Bureau Members. Graduating high school senior/continuing student must take (12 hours minimum per quarter or semester equivalent). Scholarship Types: 1. (1) First year student - $ (1) Continuing student - $ Transcripts: Certified copy of applicant s transcript for the last full year of school. This may include a combination of High school s, Community college, Junior college or University. Letter of recommendation: Three letters of recommendation must accompany the application if possible. However, if needed letters shall be submitted no later then April 1. The application shall contain the names, addresses, and telephone numbers of references. It is understood that submission of this application gives the Polk County Farm Bureau permission to utilize your name and/or picture for promotional purposes for our scholarship program. Page 4 of 6

5 The Polk County Farm Bureau Screening Committee reserves the right to make decisions and award scholarships based on the clarity and completeness of applications. The Committee further reserves the right to select scholarship recipient(s) using their best judgement of which applicants stated goals, intent and accomplishments best exemplifies the purpose of these scholarships. Because of the potential volume of applications, all queries regarding the status of their applications, becomes the responsibilities of each applicant to follow-up with the Committee or Secretary of Polk County Farm Bureau. Signature and Authorization: Applicant s signature is required. The signature of the applicant certifies the information provided in the application form is true. Parent/Guardian shall sign application as witness. The applicant agrees if selected for a scholarship, applicant will attend the institution listed and will pursue the major of study listed in the application. The applicant may changes their major as long as they stay in the field of agriculture or forestry. Applicant understands and agrees that failure to comply with the above may render the applicant ineligible for the scholarship granted and the applicant may be required to return any remaining unused portions of the scholarship to the Polk County Farm Bureau. Dated day of, 20 Signature of Applicant Witnessed by Parent/Guardian Date Page 5 of 6

6 Thank You And Good Luck We want to thank you for your interest in education and agriculture. If you have any additional questions feel free to contact The Polk County Farm Bureau Secretary Ph Mail all applications to: Polk County Farm Bureau Secretary Anne Rigor 4190 NE Hwy 20 Corvallis, Oregon Revised 2 Feb 2010 Revised 3 May 2011 Page 6 of 6

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