Farmers Union Oil

FARMERS UNION OIL
OF SOUTHERN VALLEY

Farmers Union Oil of Southern Valley will be awarding a $500 scholarship to a qualifying graduating senior from Wahpeton, Campbell/Tintah, Breckenridge, Richland 44, Fairmount or Hankinson High Schools. The scholarship will be issued to the institution the student is attending after the completion of their first semester.

Scholarship requirements:

1.  Must be a graduating senior from Wahpeton, Campbell/Tintah, Breckenridge, Richland 44, Fairmount or Hankinson High School.

2.  Fully complete scholarship application.

3.  Scholarship application must be returned by March 1, 2014

4.  Student must attend a post secondary school with 150 miles of Wahpeton/Breckenridge.

The recipient(s) will be announced prior to graduation.

Please type or print clearly.

APPLICANT DATA

______
Name (last) (First) (Middle initial) Social Security Number
______
Permanent Address (Street) (City, State, Zip)
______
Date of Birth (month, date, year) Telephone Number
Name of Parent/Guardian______
Permanent mailing address of parent/
Guardian if different from applicant ______
(Street) (City, State, Zip)
Parent/Guardian Telephone number ______

COMMUNITY INVOLVEMENT:

List all community activities in which you have participated during the past four years. (e.g. 4-H, FFA, church youth group, volunteer work, etc)

______

SCHOOL ACTIVITIES:

List all school activities in which you have participated during the past four years. (e.g. student government, music, sports, etc.) Indicate all special awards and honors. List from most recent to least recent.

Activity

/ # of Yrs
Partic. / Special Awards,
Honors, Offices Held / Activity / # of Yrs
Partic. / Special Awards,
Honors, Offices Held

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. List from most recent to least recent.

Employer / Position / Date from (mo/yr) / Date to
(mo/yr) /

Hours per

week

Please submit a typed essay (no more than one page in length) outlining your future plans and how they will have a positive impact on rural America.

CERTIFICATION:

In submitting this application, I certify that the information provided is complete and accurate to the best of my knowledge.

Applicant’s

Signature: ______Date: ______

Return to the address listed below.

Application must be received not later than March 1, 2014

Southeast Region Career & Technology Center

Attn: Farmers Union Oil Scholarship

2101 9th St N

Wahpeton ND 58075