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Scholarship Application

SOIL AND WATER CONSERVATION SOCIETY
KY BLUEGRASS CHAPTER & BAILEY-ZIMMERMAN

SCHOLARSHIP APPLICATION

 

1.   Name ___________________________________________________________

2.   Present address and phone number

Address ____________________________________________________________

Phone (    ) _________________________(Cell #)____________E-mail ____________

 

3.   Name and address of parent or guardian ___________________________________

Address ________________________________________________________________

 

4.   Occupation of parents or guardian ___________________________________________________________________

5.   Date and place of birth ___________________________________________________________________

6.   Married ____ yes ____ no

     If yes give spouse's name ___________________________________________________________________

Spouse's occupation __________________________________________________

7.   List names and ages of dependent children _____________________________

     ________________________________________________________________

8.   Other aid being received (grants, scholarships, etc.) 

     ____ yes ____ no   What kind? ___________________________________________________________________

9.  High School attended _______________________________________________

     Year graduated ___________________________________________________

10.  What year are you in college?

___________________________________________________________________

11.  What is your major course of study?

___________________________________________________________________

12.  What percentages of your funds for college have come
       from:  parents ____%, summer and part-time work ____%,
       loans ____%, scholarships ____%, other ____%.

13.  List employment history:

     Employer ___________________________________________________________

     Dates ______________________________________________________________

     Brief description of duties

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

(attach additional sheets if necessary)

14.  List positions of leadership/membership that you have held or now hold (student and community organizations)

     _____________________________________________________________________

     _____________________________________________________________________

     _____________________________________________________________________

     _____________________________________________________________________

     _____________________________________________________________________

15.  Awards and honors received

________________________________________________________________________

________________________________________________________________________


16.  Attach a maximum of a two-page essay outlining your background, attitudes towards conservation, objectives of your educational program, career plans and financial need.

17.  References:  Please attach two letters of recommendation to this application.

18.  Attach most recent transcript with grades (copy)

 

     I certify the above to be true and correct.

 

     Signature of applicant ___________________ Date_______

 

     Signature of college advisor _____________________ Date_______

Mail application with supporting materials attached postmarked no later than November 19, 2013 to: Danny Hughes, 78 Barnes Drive, Monticello, KY  42633