Scholarship Application:
Please check all that apply:
As of today, I am planning to attend the following postsecondary school:
Please Check which category best fits the insitution:
Major field of study applicant plans to pursue:
Indicate how you plan to finance your college expenses, including tuition, fees, books, room and board. Indicate if you have received other scholarships at this time and the amount received. 
Describe the home/family/farm responsibilities you have had while in high school:
Number of dependents in the family:
Number of dependents who will attend college next year:
Occupation of father:
Occupation of mother:
High School Attendance: (Number of days missed)
9th Grade:
10th Grade:
11th Grade:
12th Grade:
Check which mentor program you have been involved with:
Number of years in peer tutor: (if none put in 0)
Number of years in character counts: (if none put in 0)
High School Vocational Classes (Check all that Apply):
Please Check the college bound courses you have taken:
WORK EXPERIENCE
Describe your work experience during the past 4 years. Indicate dates of employment in each job and approximate number of hours worked each week.
SCHOOL & COMMUNITY
List all school activities in which you have participated during the past 4 years (e.g. student government, music, sports, etc.) List all community activities in which you have participated without pay during the past 4 years (e.g., Red Cross, church work, and volunteer work). Indicate all special awards and honors.
GOALS:
Make a statement of your plans as they relate to your educational and career objectives and future goals.
Include reference to your career area. For example, if you are planning an Ag-related career, discuss how you can provide a positive influence to the Ag industry; if you plan for a career in auto/diesel mechanics, explain why you are want to enter this field.
UNUSUAL CIRCUMSTANCES:
Please describe how and when any unusual family or personal circumstances have affected your achievement in school, work experience, or your participation in school and community activities.