Three easy instructions for all scholarships:

Applications must be completed and postmarked on or before Friday, January 28, 2022 to be considered by the Scholarship Committee. Applications and/or accompanying documents postmarked after Friday, January 28, 2022 will be considered ineligible.

Transcripts from each high school and college attended must accompany this application. Transcripts must be sealed by the registrar and delivered unopened.

Three letters of recommendation may be forwarded with the application or mailed directly to the Committee. Each letter of recommendation must be submitted in a sealed envelope. Letters of recommendation must be postmarked on or before Friday, January 28, 2022.

SCHOLARSHIP APPLICATION

Select Scholarship

Jimmie Cox Memorial Scholarship

Jeannie Witmer Memorial Scholarship

J.J. Crosetti, Jr. Memorial Scholarship

Laura Brown Memorial Scholarship

Name

Mailing Address

City, State, Zip

Telephone

Cell Phone

Date of Birth

Place of Birth

Marital Status

Sex

Father's Name in Full

Mother's Name in Full

Father's Birthplace

Mother's Birthplace

If married, give full name of spouse

High schools, junior colleges, and colleges attended with dates of attendance and graduation (including your present school). Do not include single courses or class studies, i.e. night school.

What scholastic honors have you received?

What citizenship honors have you received? What school offices have you held?

In what special activities such as clubs, societies, churches, athletics, or community service have you participated?

How, or from whom, did you find out about this scholarship?

What college, university, or professional technical school do you plan to enter or are you attending?

When?

Major course of study

For what occupation are you preparing?

Have you been or are you now the beneficiary of a scholarship or other award? If so, provide names and amounts.

Will you work while attending college?

Letters of Recommendation: Applicant must submit three letters of recommendation giving information about his/her character, ability and financial needs. Remember, each letter of recommendation must be submitted in a sealed envelope.

List the names and occupations of the persons (relatives excluded) who are writing the letters of recommendation:

Other members of immediate family (Relationship, Age (if under 21), Degree of dependency (entirely, ½, etc.)):

Do you have brothers or sisters in college? If yes, state age and year in college.

Will you be living at home or on campus?

Write a short biography including reasons for choosing your major. Include your past and present financial circumstances and your plans for the future. *

Complete the following two questions ONLY if you are applying for the Jeannie Witmer Memorial Scholarship.

Required: What years did you participate in High School Rodeo and/or 4-H horse programs.

Not required but preference given: What school, 4-H or Rodeo offices have you held?

Complete the following question ONLY if you are applying for the Laura Brown Memorial Scholarship.

Not required but priority given: Please list the dates of your 4-H membership and offices you have held.

CONFIDENTIAL (To be reviewed by Scholarship Committee only)

What savings are available for your education?

Do you have any debts? If so, state amount

Annual income of parents or guardians

If spouse of parent or guardian has separate income, indicate amount.

What amount will be provided each month by parents or guardians, other relatives or friends toward your college expenses?

Estimated Income for College Year

Cash on hand at beginning of period:

Prospective earnings during period:

Financial aid from parents or others:

Total Income:

Estimated Expenses for College Year

Tuition and fees:

Books and instruments:

Clothing:

Recreation:

Board and room:

Organizations:

Insurance:

Travel expenses:

Incidentals: (itemize)

Total Expenses:

Amount needed to balance budget

Are you willing to give the Committee a full report of your progress at any time?

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