|
Midland Conservation District Scholarship Application
|
|
|
APPLICANT INFORMATION |
|
|
First Name: Last Name: MI: |
|
|
Applicant Telephone Number: SSN: |
|
|
Home Address: |
|
|
City: State: Zip Code: |
|
|
Gender: □ Male □ Female |
U.S. Citizen: □ Yes □ No |
|
High School Name: |
|
|
High School Phone Number: |
|
|
Address: |
|
|
City: State: Zip Code: |
|
|
High School Principal’s full name: |
|
|
FAMILY INFORMATION |
|
Father’s/Step Father’s/Guardian’s Full Name: |
|
Mother’s/Step Mother’s/Guardian’s Full Name: |
|
Address (if different): |
|
City: State: Zip Code: |
STUDENT CERTIFICATION |
I am currently a: □ High School Senior □ College Freshman □ Other: |
The academic area of study I plan to pursue is: |
My intended school is a:□ Two Year College/University□ Four Year College/University□ Two Year & Then Transfer to a Four Year College/University□ Trade School
Name of School: |
Midland Conservation DistrictScholarship Application
|
ACADEMIC INFORMATION |
|
A COPY OF YOUR TRANSCRIPT MUST ACCOMPANY THIS APPLICATION |
This applicant’s class rank is in a senior class of students. |
|
Cumulative GPA of on a 4.0 scale. SAT Score: or Act Score: |
|
I certify that the above information is current and correct:
High School Principal/Guidance Counselor Signature: |
NEWSPAPER INFORMATION |
Local Newpaper Name: |
Newspaper Address: |
Newspaper City: State: Zip Code: |
ACTIVITY INVOLVEMENT |
|
|
List involvement and achievements in school and community activities. |
|
|
Activity: |
Year: |
1. |
|
2. |
|
3. |
|
4. |
|
5. |
|
6. |
|
7. |
|
8. |
|
9. |
|
10. |
|
|
Midland Conservation District Scholarship Application
|
STUDENT STATEMENT |
In essay form (450 words or less) please explain why the scholarship committee should select you as a recipient of this scholarship. Please attach to this application. |
TEACHER/GUIDANCE COUNSELOR STATEMENT (optional) |
In the space below, please provide a brief evaluation of the applicant’s academic program, extra-curricular involvement and potential for success in the chosen career. |
SIGNATURES OF APPLICANT AND PARENT |
|
I (WE) CERTIFY that all information on this form is true and complete to the best of my (our)knowledge. Date: |
|
Applicant Signature: |
|
|
Parent(s)/Guardian(s) Signature: (only required if applicant is under 21) |
|
|
Please mail this completed application, along with essay and transcript to: Midland Conservation DistrictAttn: Scholarship Committee 275 W. Saginaw Road Sanford, MI 48657 |