The First National Bank of Centralia

The First National Bank of Centralia

2010 Scholarship Application

(Application Due to Lisa Schmitz: April 26, 2010)

Section 1: Information to be provided by the applicant. (Please type, print, or provide on a separate sheet.)

Name: ______SSN: ______

Date of Birth: ______Phone # ______

Address: ______

Parents’ Full Names: ______

Activities: Please summarize your top 10 school and community/service activities. List organizations in which you are or were a member and leadership positions held. Note timeframe of involvement and time commitment.

Organization or Activity / Dates or Timeframe Involved / Leadership Position / Time Commitment /
(example)Boy Scouts of America / All 4 years HS – currently active / Eagle Scout Candidate / 3 hours/week /
(example) Student Council / Junior Year / Elected Jr class representative / 2 hours/month /
(example) Community Food Drive / December 2006 / None / 10 hours (one-time event) /

Essay #1: Please describe what you believe has been your greatest challenge overcome or your greatest accomplishment/achievement.

Essay #2: Please summarize your educational and short- and long-term goals.

______

Signature of Applicant Date

Section 2: Information to be provided by the principal or counselor.

This is to certify that this applicant, ______, ranks ______in a class of ______seniors and will graduate from ______High School on May ______, 2007. The applicant’s grade point average through the first semester of his/her senior year is ______on a scale of ______(highest GPA possible). The applicant has taken the following college entrance examinations(s) under a statewide testing program:

Name of Test Composite Score College Bound Rank

______

Signature of Principal or Counselor Date