Application Deadline June 1, 2015
Applications must be typedneatly to be considered. All word count limitations
must be followed. A student can only receive the Student Leader Scholarship up to two times during their academic career. Five scholarships are allotted as Pennsylvania Dairymen’s Association Scholarships and two are designated as Center for Dairy Excellence Foundation. For more guidelines or an electronic copy, go to:
1. Personal Information
______
NameBirth date (mm/dd/year)
______
Permanent (home) AddressCityStateZip
______
Parents NameHome Phone #
______
Campus AddressCityStateZip
______
Campus/Cell Phone #Applicant’s Email Address
Male:______Female:______Current GPA or Academic Standing:______(also attach transcript)
2. Educational Information
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College or University
______
Academic Major Department Semester Classification for 2015-16 (Fr, So, Jr, Sr)
______
Academic Advisor orContact PersonTitle/Relationship
Advisor Phone Number: Advisor Email: ______
3. Please answer the following questions limited to the space provided.
a) Briefly describe yourself in terms of history, family, and dairy experience.
b) Identify what you consider to be your top five leadership roles and/or accomplishments and explain why. (Limit your answer to 300 words or less.)
c) Describe one situation in which you have demonstrated integrity and character in your own life.(Limit your answer to 150 words or less.)
d) Looking ahead, explain how you see yourself involved in the Pennsylvania Dairy Industry? Share one five-year personal goal regarding your vocation.(Limit your answer to 250 words or less.)
e) Not including family members, identify a specific individual within Pennsylvania’s dairy industry that you most admire and describe why you would like to emulate them.(Limit your answer to 150 words or less.)
f) Identify a current public issue you believe is influencing the dairy industry at large and identify the key action items that should be accomplished to address it.(Limit your answer to 250 words or less)
I certify that the information contained in this Student Leadership Scholarship application submitted by me is correct and was prepared by me. I further give permission to the Center for Dairy Excellence to use my name, photo, and information contained within the application to promote this scholarship program in news releases, newsletters, web sites, and other media outlets.
Signed: ______Date: ______
Please send or e-mail your application by June 1, 2015, to:
Jayne Sebright, Communications Director
Center for Dairy Excellence, 2301 North Cameron Street, Harrisburg, PA17110
Phone: 717-817-1376 Fax 717-705-2342 Email:
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