Macon County Farm Bureau
Scholarship Application
Deadline – February 15, 2017
UNDERGRAD STUDENTS MAJORING IN AN
AGRICULTURAL RELATED FIELDARE ELIGIBLE TO APPLY
Dale & Marge Christison Scholarship
Emmett Sefton Memorial Scholarship
Macon County Farm Bureau Foundation Scholarship
Macon County Young Farmers Scholarship
- Open to Macon County Farm Bureau members -
Willard Severns Leadership Award
- Open to Macon, Christian, Shelby, Moultrie, Piatt, & DeWitt County Farm Bureau members –
Please note: Additional scholarship opportunity:
(Must apply for this scholarship separately via the link listed below)
Mary. K Heckel -Blickle Memorial Scholarship
The Mary L. Heckle-Blickle Memorial Scholarship will provide a $1,000 college scholarship annually to a student who resides in Kane or Macon County Illinois. Macon County Farm Bureau members and their college students are encouraged to apply. Application and scholarship requirements may be found on .
*Applicant must major in an ag related field of study*
Instructions:
1. Only online submissions will be accepted. No hand written applications will be accepted.
2. Fill in ALL of the blanks applicable to you in the form.
3. Submit all of the following to the Macon County Farm Bureau:
- Letter of acceptance from the College or University you will be attending
- 1 letter of recommendation from a teacher
- 1 letter of recommendation from a personal reference (not related to you)
4. Documents must be postmarked byFebruary 15, 2017to:
Macon County Farm Bureau
Attn: Scholarship Committee
1150 W. Pershing Road
Decatur, IL 62526
Questions? Please call 877-2436 or visit the Macon County Farm Bureau.
INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
Macon County Farm Bureau
Scholarship Application
Deadline – February 15, 2017
County Farm Bureau Membership Number Including Name of County*
You or your parents must be a member of the Macon County Farm Bureau to apply for the Dale & Marge Christison, Emmett Sefton Memorial, Macon County Farm Bureau Foundation, and Macon County Farm Bureau Young Farmers scholarships. You or your parents must be a member of the Macon, Christian, Shelby, Moultrie, Piatt or DeWitt County Farm Bureau to apply for the Willard Severns Leadership Award.
Full Name*
Please provide your full name, including middle initial.
Birthdate*
Age*
Gender*
Contact Information
Street Address*
City*
State*
ZIP Code*
County*
Township*
Home Phone*
Cell Phone*
Primary/Personal Email Address *
College/University Information:
School Email Address*
University/College Student ID#* (If applicable)
University Financial Aid Office Contact Information:
Please list the mailing address of the financial aid office of the college or university in which you plan to attend
Name*
Financial Aid Office Street Address*
City*
State*
ZIP Code*
Academic Information
High School Name*
High School Scholarship Night Info
If still in high school, please list your scholarship night information so that a Farm Bureau representative may attend (date, time, place).
Date of Graduation*
Class Rank*
Please list your class rank in the format ### of ###.
Grade Point Average*
Please list your GPA and the point scale system used to calculate it.
ACT and/or SAT score*
Academic Plans
What college or university will you be attending this fall?*
Major*
Must be ag related.
In the fall, which will you be: Freshman, Sophomore, Junior or Senior:*
If you are currently in college, what was your cumulative GPA as of last semester?
Are you, or will you be a full time student?*
Financial Information
Other Scholarships and Financial Assistance*
Have you applied for other scholarships or financial assistance? If so, list the names and amounts and whether you have already been approved. Also, please indicate if you have submitted a FAFSA and if you qualify for Pell Grant or work-study.
Current Financial Obligation*
What is the current amount of debt incurred by you for your college education and how are you intending to eliminate that debt?
Family Information
Adjusted Gross Income*
Please indicate your family’s Adjusted Gross Income average from the last five years' tax returns.
Total Number of Family Members Living at Home*
Children*
Ages*
Number attending college?*
Other Financial Considerations*
Agriculture Related Activities, Awards, and Achievements*
List any agriculture related activities, awards, or achievements.
Extra-Curriculars and Honors*
List any extra-curricular school activities in which you have participated. Please include any offices held, awards or achievements received.
Community and Service*
List any community, religious, or other service organizations in which you have participated. Please include any offices held, awards or achievements received.
Employment
Are you currently employed?*
If yes, where do you work, and how many hours per week do you work there?
Describe any other work activities and responsibilities*
(such as family farm, helping at home, family business, etc.)
Essay*
Please describe why you want to be the recipient of the scholarship(s), the course of study or major field of interest you plan to follow, your proposed occupation or profession, and any other abilities you have not previously mentioned in this application. Please also list three books you have read that are your favorite or have inspired you and indicate why.
(Please enter your essay here)
Personal References
Unrelated Personal Reference
Name*
Position*
Address*
Home Phone*
Work Phone*
Teacher
Name*
Position*
Address*
Home Phone*
Work Phone*
Digital Signature
I HEREBY CERTIFY THAT THE ENCLOSED STATEMENTS AND MY ATTACHED ESSAY ARE MY OWN WORK, AND ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I WILL SUBMIT A COPY OF THE FOLLOWING DOCUMENTS TO THE MACON COUNTY FARM BUREAU:
Certification of Authenticity*
Letter of acceptance from the college or university you will be attending
Letter of recommendation from a teacher
Letter of recommendation from a personal reference (not related)
I understand if any of the listed documents are missing, my application will not be processed.
Signature*
Please type your full name into the text field. By doing so, you acknowledge that you will be available for recognition at a specified Macon County Farm Bureau function, and that the information provided is true and correct to the best of your knowledge.