LAKE COUNTY FARM BUREAU
70 US HIGHWAY 45
GRAYSLAKE IL 60030
AITC (Agriculture in the Classroom) SCHOLARSHIP
APPLICATION FORM
GENERAL REQUIREMENTS FOR APPLICANTS FOR SCHOLARSHIP
1.Complete transcript of high school and any college course credit which has been completed
2.Scores of College Board Examination and/or other standardized test (ACT, SAT)
3.Completion of application form in detail
4.Possible interview with scholarship committee
5.Payment of monies for scholarship will be made directly to school when applicant has
been accepted and admitted. It may be used for tuition, fees and related academic expenses or room and board after any other scholarship money has been applied
SPECIFIC REQUIREMENTS FOR SCHOLARSHIP
1.MUST have a Course of study in agriculture or a related field
2.Applicants or parents/guardians must be residents of Lake County, IL
3.Applicant must be a member, or be the son or daughter of a Farm Bureau member, with an active membership for at least two years
4.Students are not eligible for this scholarship if they have received any other LCFB Scholarships in the past
INSTRUCTIONS
1.Complete personal history form
2.Give recommendation blank to proper school officials
3.All material must be returned to the Scholarship Committee by May 1, 2018 to be considered
LAKE COUNTY FARM BUREAU
70 SOUTH HIGHWAY 45
GRAYSLAKE IL 60030
AITC SCHOLARSHIP
RECOMMENDATION FORM: To be filled out by High School Principal or Counselor,College Registrar, Dean or Counselor
Applicant:Name ______
Address ______
City State Zip Code ______
Phone Number ______
Does this student have the potential for completing college work? ______
Does he/she have the aptitude for his chosen field? ______
In your opinion is applicant a worthy recipient of this scholarship? ______
Has student been a good citizen? ______
Please comment: ______
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Does applicant have your unqualified endorsement? ______
If not, why? ______
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Use this space to answer any questions more fully and to list and explain any additional information you feel the Committee should have to properly appraise the merit of this applicant
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Signature ______
School ______
Title Date ______
APPLICANT’S PERSONAL HISTORY
Date of birth Place of birth ______
Social Security number Farm Bureau number ______
Lake County resident? Number of years ______
Parents’ names ______
Name of school now attending ______
Address ______City/State/Zip ______
Year in school: High School Senior _____
College Freshman Sophomore Junior Senior
APPLICANT’S FINANCIAL SITUATION
Assets: Savings, investments, etc$ ______
Debts: College and/or other$ ______
Estimated employment while in college: Hours/week
Earnings/month$ ______
EMPLOYMENT
Describe any part time employment, during school, summer or other ______
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How much was earned during the last two years? ______
Present employer: Name ______
Address ______
Type of work and responsibilities ______
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EDUCATIONAL PLANS
College or school you plan to attend:
Name ______
Address ______
City State Zip Code ______
Have you been accepted at above named school? ______
Counselor’s name ______
Tuition Account number______
Anticipated expenses for next school year:
Tuition $ Fees and academic expenses $ ______
Room and board $ Other $ ______
Educational goal ______
Do you expect to go to college full time or part time? ______
If part time, what percentage? ______
State your reasons why ______
ACADEMIC QUALIFICATIONS
High school rank In a class of ______
High school grade point average ______
College grade point average ______
Awards, honors, other recognition received in the past two years ______
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List other scholarships you have applied for and their value ______
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Have any monetary scholarships or grants been awarded to you at the present time?
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If yes, indicate value and name of grant or scholarship ______
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State reasons you desire to study in the field you have chosen and any other factors you feel important to the Committee in considering your qualifications for a scholarship
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ENDORSEMENTSI hereby state that the above information is complete and correct and fulfills the requirements for this scholarship.
______Signature of Applicant Date
I have read his application as completed and to the best of my knowledge and beliefs, the information is complete and correct
______Signature of Parent or Guardian Date