Edgar & Mabel Robertson Scholarship

Application Form

Full Name______

Graduation Date:______Cumulative GPA______

Class Rank______of______

Letters of recommendation (to be attached to this form) to be written by:

______teacher

______teacher

______unspecified

  1. Give a brief description and examples to demonstrate your own positive work ethic.
  1. Describe your participation in community service projects. Include: duration and number of years of service. (i.e. babysitting at church1 hour for a month = 4 hours)

What did you learn most from your community service?

  1. What are your future educational and vocational plans?
  1. If you have decided on a specific career, why have you decided to pursue this specific career?

5.Who is someone you greatly admire and why?

6.What do you most appreciate about the Cheylin community? What do you plan to do to demonstrate this appreciation?

7.Knowing what you now know, what would you change, if anything,about choices you made during your high schoolyears?

8.Who are Edgar and Mabel Robertson?

Edgar & Mabel Robertson Scholarship

c/o BirdCity Century II Development Foundation

PO Box 593 Bird City, KS 67731

TEL 785-734-2556 EMAIL

Letter of Acceptance

Date ______Amount $ ______/ Per Semester $ ______

I, ______, hereby accept the Edgar & Mabel Robertson Scholarship Award from the Bird City Century II Development Foundation, an affiliate of Greater Northwest Kansas Community Foundation, a Kansas non-profit corporation, subject to the conditions set forth in this Letter of Acceptance.

I understand and agree that this scholarship award is available for three years from this date, but can only be used for two (2) years of expenses to attend a college, university or vocational/technical college. I understand that this scholarship award will be divided and paid out equally over 4 semesters, or 2 years. I understand that this scholarship award will be paid to the college and myself, at the beginning of each semester or course block that I am enrolled in as a full-time student at a college, university or vocational/technical college, and provided I meet the other conditions stated in this Letter of Acceptance.

I understand and agree that by accepting this scholarship award that I will maintain a minimum of a 2.5 cumulative grade point average. In the event my cumulative grade point average drops below the minimum grade point average, I will be placed on probation for one semester. I understand that if placed on probation, I will not receive any of the scholarship awards until I am reinstated. I understand that I may be reinstated if my cumulative grade point average equals or exceeds the minimum grade point average. I understand and agree that I will need to apply to the Bird City Century II Development Foundation for reinstatement, at which time the previous semester funds will be given to me. After two consecutive semesters of failure to meet the minimum cumulative grade point average will result in forfeiting all scholarship awards permanently.

I understand and agree that at the end of each semester I shall present verification of my grades to the Bird City Century II Development Foundation. I understand and agree that the scholarship award will terminate if I fail to present proof of my grades,and verification of enrollment for the upcoming semester, to the BirdCity Century II Development Foundation before the next semester begins. If, for any reason, the institution will delay grades, I understand that I must inform the Bird City Century II Development Foundation of the delay. I understand that the Bird City Century II Development Foundation may delay payment of the remaining amount of the scholarship for failure to present proof of meeting the cumulative minimum grade point average requirement.

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I understand and agree that the receipt of this scholarship award is conditional upon my providing a written report, or if requested, a personal report to the Bird City Century II Development Foundation. This report will include my name, the college, university, or vocational/technical school attending, field of study, and my degree completion status.

I understand and agree that good citizenship is an important criterion for the receipt of this scholarship award. Community service throughout my high school years will play a large role in determining my eligibility for this scholarship.

I understand and agree that it is my responsibility to determine what amount, if any, of the scholarship award is taxable as income, and to report the same under the Internal Revenue Code and any applicable state law.

I have read and understand this Letter of Acceptance for the Edgar & Mabel Robertson Scholarship and the conditions contained within, and I agree to comply with these conditions for the duration of this scholarship award.

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Signature

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Printed Name

______

Address

______

City, State, Zip

______

E-mail Address

______

Social Security Number

Updated 9/21/11