Galesburg High School Scholarship Application

(Please Type)

Part I: Personal/Contact Information

Last Name: ______First Name: ______Middle Initial: ______

Parent/Guardian’s Name(s): ______

Address: ______City: ______State: Illinois_ Zip Code: ______

Phone Number: ______E-Mail Address: ______

Birth Date: ______Gender: ______

Part II: Academic Information

Current GPA: ______Class Rank:______Highest ACT Composite Score: ______

Part III: Future Plans

College or University you plan to attend next fall (you may list your top three choices if undecided)

Name of School: ______Location (City & State): ______

Intended Major: ______

Part IV: School Related Activities and Achievements

In the space provided please list any school related extra/co-curricular activities that you have participated in along with any awards and achievements you have earned. Please include the year(s) as well.

______

Part V: Community Related Activities and Achievements

In the space provided please list any community related activities that you have participated in along with any awards and achievements you have earned. Please include the year(s) as well.

______

Part VI: Employment History

In the space provided please list previous or current places of employment, dates of employment, and job description

Name of EmployerDates of EmploymentJob Description

______

Part VII: Recommendations

Please include two letters of recommendation with your application. Letters of recommendation may come from either a teacher, counselor, coach, principal, employer, or clergy, etc. At least one letter must come from a representative of Galesburg High School. You may not have parents, relatives, or friends submit letters of recommendations on your behalf. Letters of recommendation should be submitted with your application.

Part VIII: Essay

In the space provided please answer both essay questions. Please do not include on a separate document.

Essay Question 1: Please list how you have made a difference to Galesburg High School and the Galesburg Community and why you would be a deserving recipient of a Galesburg Public School Foundation Scholarship(s).

______

Essay Question 2: Please describe what your future career will be and what has motivated or inspired you to enter that career field.

______

Part IX: Galesburg Public School Foundation Scholarships

Please place an X on the line next to the name of the scholarship you are applying for. Please make sure you have verified that you are eligible to apply for these scholarships. You only need to turn in one application. You do not need to turn in an application for each scholarship you are applying for.

___ Allric Anderson Memorial Scholarship___Marjorie Preston Sargeant Memorial Scholarship

___Art Fish Tennis Scholarship___Maury Beck Scholarship

___Bernice Henry Howard Scholarship___Max Wine Memorial Scholarship

___Charles F. West Memorial Scholarship___Morgan Family Basketball Scholarship

___Dave’s Auto Body Scholarship___Ray Kroc- McDonald’s Golden Arches Scholarship

___Dustin Frazier & Quinn Dombrow Memorial Scholarship___Rotary Galesburg Sunrise Scholarship

___Galesburg High School Class of 1959 Scholarship___Roy F. Damburg Honor Scholarship

___George W. and Janet M. Lundeen Memorial Scholarship___Rose Skaloud Memorial Scholarship

___Helen Scharfenberg Peters Memorial Scholarship___Scholastic Bowl Scholarship

___Irma Gale Girls Service League Scholarship___Spark Burgland Memorial Basketball Scholarship

___Jason Gray Memorial Scholarship___Stephen Michael Flanagan Memorial Scholarship

___Jesus Sebastian Esquivel Memorial Scholarship___Student Action for Education

___KaLee N. Pringle Memorial Fire Science Scholarship___Verna May Vocal Scholarshi

___KaLee N. Pringle Memorial Law Enforcement Scholarship___Wanda B. Sargent Memorial Art Scholarship

___Louis Lakis Memorial Scholarship

Part X: Authorization

Please sign your name below to indicate that all the information you have provided is accurate and that you allow this information to be shared with those who are on the scholarship selection committees (administrators, teachers, counselors, and community members). Failure to sign your application will not allow you to be selected to receive any scholarships through the Galesburg Public School Foundation.

Signature: ______Date: ______

Please remember to include the following with your application:

1-Grade History Report (see your counselor)

2-Letter of Acceptance from the college/university you plan to attend in the fall

3-Two letters of recommendation

4-A sealed manila envelope or folder with your application along with the items listed above

Application Packet is due to Mr. Bredemeier on March 16th, 2017!!!