Joyce Smith Memorial Scholarship Fund

JOYCE SMITH MEMORIAL SCHOLARSHIP FUND

Club de l’Epagneul Breton of the United States

The Joyce Smith Memorial Scholarship Fund was established to assist a graduating high school student entering college to pursue an accredited course of study. The fund was created in honor and memory of Joyce Smith, a founding member of what is now the Club de l’Epagneul Breton of the United States. A memorial of Joyce’s contributions can be found in issue 33, page 5, of the club’s magazine L’Epagneul Breton.

Successful applicants will meet the following listed criteria:

•  Graduate from high school during current academic school year

•  Member of CEB-US as an individual or child of a family membership for the continuous past 3 years.

•  Student applicant has participated in club activities such as: field trial, conformation show, junior handler, bird planter, etc.

•  Applicant will submit a written essay, suitable for the club magazine, telling how the interaction with the Epagneul Breton has impacted his or her life.

•  Applicant is accepted at an accredited college or university.

•  Application is received by deadline date of entry.

Please send the following Application Form and Applicant Certification to:

Ed Smith

13264 S. 1025 E.

Galveston, IN 46932

Email:

Also please email a copy to: John Hutwagner

Email:

Application Form

CEB-US Joyce Smith Memorial Scholarship Fund

Name: ______

Address: ______

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Age: ______

Phone: ______

Email: ______

Please list extracurricular activities and any awards or honors you may have received:

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Please list any community organizations, charities, or churches you are involved with and how

you participate with them:

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Name of college or university you plan to attend:

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9. Please provide an essay describing how your interaction with the Epagneul Bretons has

impacted your life:

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Applicant Certification

I hereby certify to the board of the CEB-US and selection committee of the Joyce Smith Memorial Scholarship Fund, that the information provided as a part of this application process as well as any information I provide in an interview is true and correct to the best of my knowledge.

I acknowledge and understand that the CEB-US Joyce Smith Memorial Scholarship Fund is a nonprofit entity and any decision or award by the CEB-US or the selection committee is final, I do not have any appeal, claims or causes of action against the Fund, CEB-US board members or the selection committee members.

I understand that any award received is a one-time event and the amount of the award is the decision of the CEB-US Board based on the amount of funds available and the number of applicants awarded in the particular academic school year under consideration.

I hereby give the CEB-US Joyce Smith Memorial Scholarship Fund, the right to use my name, likeness and image for publicity and indemnify and hold harmless CEB-US board members and committee members, both in their official capacity and individually.

Applicant Signature: ______Date: ______

Parental Certification

I certify that the information in the foregoing application pertains to my son / daughter is true and correct. That I have read, understand, acknowledge and affirm the foregoing certification of my child.

I hereby give the CEB-US Joyce Smith Memorial Scholarship Fund, the right to use my child’s name, likeness and image for publicity purposes and indemnify and hold harmless CEB-US board members and committee members, both in their official capacity and individually.

Parent Signature: ______Date:______