John A. Johnson Scholarship Foundation

JOHN A. JOHNSON SCHOLARSHIP FOUNDATION

APPLICATION FOR SCHOLARSHIP AWARD

Wells Fargo Bank Montana, N.A., as Trustee for the John A. Johnson Scholarship Foundation, is seeking applicants for scholarships. The Scholarships are available:

To one or more students in the graduating class at Anaconda

High School or graduates thereof, as an aid and inducement

to further the education of such recipient(s) at any recognized

college or university of choice.

This form should be completed by the applicant and submittednoLATER THAN APRIL 1st, a copy of the applicant’s transcript; three (3) character references, only one of whom is associated with the applicant’s high school or college; and a completed Financial Data Form (attached). Please submit all forms to:

Anaconda Public Schools

AHS Counseling Office

Joe Casey

515 Main Street

Anaconda, MT 59711

Applications should be typed or neatly printed.

Date of Submission Social Security Number

Applicant’s Name

Address

City, State Zip

Date of Birth Place of Birth

Father’s NameFather’s Occupation

Mother’s NameMother’s Occupation

Guardian’s Name (If other than Parent) Guardian’s Occupation

Address of Parent/Guardian (If different from yours)

Date of Graduation from High School

Number in Class Rank in Class G.P.A.

High Schools previously attended:

Name:

Place:

Years:

Honors in high school or other schools

High school activities

Out of school activities

Summer and part-time employment

JOHN A. JOHNSON SCHOLARSHIP FOUNDATION

In 200 words or less, please summarize your higher educational objectives and career goals, stating why you have chosen as you have and how this scholarship will help you achieve your goals.

If awarded the John A. Johnson Foundation Trust Scholarship, I agree to attend the following school of my choice for the one-year term of the award.

Address:

I understand that if I do not complete a one-year period that I will reimburse the Foundation a pro rata share of my award.

I understand that the scholarship funds are for the payment of:

1. Tuition

2.Fees

3.Board and room, and

4.Books and other study materials

I understand that the funds cannot be used for travel expenses.

I will submit to Wells Fargo Trust and Investment Center, Attention Sharon M. Ayers, P.O. Box 95021, Henderson, NV 89009-5021 the following:

1.Each quarter/semester a transcript of grades

2.An accounting of expenses

I understand that the John A. Johnson Foundation Trust Scholarship can be terminated for lack of diligence and success on my part or failure to quarterly account for scholarship funds in a manner determined by the Trustee.

Dated this ______day of ______, 2013

Sincerely,

______

Applicant’s Signature

FINANCIAL DATA FORM

Estimate of Funds Needed During Ensuing College year:

Tuition and Fees______Books and Supplies______

Room and Board______Personal Requirements______

TOTAL NEEDED $______

Expected Personal Financial Resources During Ensuing College Year

(Income from these or any other sources will not disqualify the applicant, but will be considered along with other factors):

Savings or other funds on hand______

Scholarships______

Parents______

Employment______

Other______

Total Funds Available $______

Total Needed less Total Available $______

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