Electronic Version

2012

Hintzsche Scholarship for Agriculture

Program Application

GENERAL INFORMATION

Applicant’s Name / Applicant’s Telephone Number
Applicant’s Address / City, State Zip
Applicant’s E-mail Address
Applicant’s High School / High School Major Courses of Study
College / University / Tech. School / Planned Major Courses of Study
Name of Applicant’s Parent / Guardian

SCHOLASTIC ACHIEVEMENT

Applicant’s Class Rank (at end of 7 semesters) / Class Size
Weighted GPA (4.0 scale) / Unweighted GPA (4.0 scale)
ACT Score / SAT Score

Please submit the following:

v  Official Transcript of Applicant’s High School Credits

v  Copy of Applicant’s ACT (or SAT) Scores

v  Personal photograph (head and shoulders)

[This photograph will not be returned and will be used for promotional release only, in the event the applicant is a scholarship winner.]

LEADERSHIP ACTIVITIES

Activity / Class/Year / Achievement and/or
Participation Level

EXTRA-CURRICULAR OR COMMUNITY ACTIVITIES

Activity / Year / Achievement and/or
Participation Level

CAREER OR VOCATIONAL INTERESTS

WORK EXPERIENCE

Year / Employment or Project

ESSAY

Please include a short essay, not to exceed two pages in length (double-spaced), incorporating the requirements below. Be sure to include your name at the top of each page.

ESSAY REQUIREMENTS: 1) Describe an experience or event that caused you to pursue the particular area of agriculture studies you are embarking upon, and 2) explain how you will likely apply your educational experience to your future career.

COUNSELOR COMMENTS ON THIS APPLICANT

Counselor or Advisor: Please provide an evaluation of the applicant’s scholastic performance, activities, leadership capabilities, and character. Thank you.

(This section will automatically expand; however, you may attach a separate letter if you so desire.)

CERTIFICATION

I hereby certify that the information contained in this application is true and accurate. I understand that all information contained in this application is subject to verification and that false information will lead to disqualification.

Applicant’s Signature / Date
Parent/Guardian’s Signature / Date

APPLICATION DEADLINE: February 13, 2012

Please submit completed application to the address below.

You may print your application and mail it to our address listed below, or if you would like to e-mail your application, please send it to . Either way, however, your application must include the required signatures (above).

Hintzsche Fertilizer, Inc.

Attn.: Joanne Hueber

2s181 County Line Road

Maple Park, IL 60151

If you have questions, please contact Joanne Hueber via e-mail at jhueber@ hintzsche.com, or by calling 630-557-2406 or 800-446-3378.

Please note:

·  All applications must be received by the Application Deadline.

·  Any application that does not include all of the required documentation will not be accepted.