DONALD G. and PAULINE (POLLY) SPEICH
MEMORIAL SCHOLARSHIP FUND
NEILLSVILLE, WISCONISN/GREENWOOD, WISCONSIN
PERSONAL INFORMATION:
Name:
Home Address:
City: State/Zip:
Parents Names:
Number of people in household:
What are your plans or goals after high school?
If you are going to school, what program will you study?
How will you use this education in your future career?
How do you plan to finance your schooling?
What percent of the cost is your responsibility?
What is your parents’ percent of cost?
Other?
List other scholarships you have been awarded and amount of each.
Record your participation in school, community, and civic and other activities.
GRADE 9 GRADE 10
GRADE 11 GRADE 12
Enumerate any outstanding achievements in music, speech, science, sports or other areas.
1. Write an essay in which you tell the selection committee of the Donald G. and Pauline (Polly) Speich Memorial Scholarship Fund of your personal qualifications, your school and community activities and accomplishments, and why you are interested in this scholarship. It would be appreciated if you could discuss your financial situation, need for scholarship, etc.
2. List any courses, which you have taken which could be considered as college preparatory or advanced areas of study. Comment on these classes and tell how you feel they have prepared you for your chosen field or college in general.
3. In reading and evaluating your application, the scholarship committee hopes to gain as complete a picture of you as possible. However, our knowledge of you is necessarily limited to the information you provide to us. Please use this page to tell us anything about you that you think we would know about your qualifications and / or need of the Donald G. and Pauline (Polly) Speich Memorial Scholarship Fund.
4. To enable the scholarship committee to know your academic and extracurricular interests better, please respond in essay form to one of the following.
a. Describe an intellectual experience of the past two years that has given you great satisfaction.
b. Which activity in or out of school in most meaningful to you? Why?
5. If you were given the opportunity to spend a day with any one person living, deceased, or fictional, with whom would you choose and why? (We are interested here not so much in whom you choose, but in how you use your choice to illustrate something important about yourself, your values, the kind of person you are or hope to become)
IMPORTANT: Three written recommendations are needed from non-relatives, including: (a) a civic leader (b) a business leader (c) one of your own choosing.
Have your references sent their recommendations to the following address by the application deadline: March 1, 2017.
Elaina Boyle
Neillsville High School
401 Center Street
Neillsville, WI 54456
Application Deadline: March 1, 2017.
NOTE: You may be asked to attend a personal interview with the committee.
Please attach an additional page with any other pertinent information, financial or otherwise, that you would like the scholarship committee to know.
THANK YOU
My signature below authorizes members of the Donald G. and Pauline (Polly) Speich Scholarship Committee to view my official school records. It is also understood all information and references provided to the committee will be used for the exclusive purpose of awarding Donald G. and Pauline (Polly) Speich Scholarships and that this information will remain confidential property of the committee and will be revealed or released to any other person or organization. (If student is a minor, a parent must also sign)
Signature of Student Signature of Parent (if required)
Date Date
For Office Use Only
Application received on ______________________, 2016 by ________________________________.
It is the policy of the School District of Neillsville that no person may be denied participation in, be denied the benefits of, or be discriminated against in any curricular, co-curricular, pupil service, recreational or other program or activity on the basis of the person’s sex, race, religion, national origin, ancestry, creed, pregnancy, marital or parental status, color, sexual orientation, or physical, mental, emotional, or learning disability or handicap as required by section 118.13, Wis. Stats. This policy also prohibits discrimination as defined by Title IX of the Education Amendments of 1972 (sex), Title VI of the Civil Rights Act of 1964 (race and national origin), and Section 504 of the Rehabilitation Act of 1973, which prohibits discrimination on the basis of disabilities.
All student educational and extra-curricular programs and employment opportunities follow the district’s policies of nondiscrimination. In addition, arrangements can be made to ensure that the lack of English language skills is not a barrier to admission or participation. Any questions or complaints should be directed to:
John Gaier, District Administrator
School District of Neillsville
614 East 5th Street
Neillsville, WI 54456
(715) 743-3323
e-mail: