PIERCE & PEPIN COUNTY HOLSTEIN ASSOCIATION
$250.00 SCHOLARSHIP APPLICATION FORM
This form is to be completed by the applicant and returned to UW Extension Office, PO Box 69, Ellsworth, WI 54011 before April 15th, 2016.
Eligibility Pierce & Pepin County residents who plan to further their education in an agriculturally related field.
Applicant ______
Home Address ______
Township ______County ______
Place or residence (check one): ____ Farm ____ City ____ Rural Area Outside of Town ____ Village or Town
Place and date of birth ______/_____/____
Mo. Day Yr.
If you are a high school Senior, indicate name and address of school or college you plan to attend as an incoming Freshman:
______
Name and address of school or college you are now attending:
______
Year of school (this fall): _____ Incoming or current Freshman
_____ Sophomore _____ Junior _____ Senior _____ Graduate School
Field in which you plan to major: ______
Schools attended:
A. Secondary schools ______
B. Date of graduation ______Scholastic Average ______
C. Ranked ______in a class of ______(# in graduating class)
D. Higher institutions attended:
Name of Institution: ______
Dates of Attendance: ______
Scholastic Average: ______
List any college scholarships you have previously received, by year, name and value:
______
______
Are you or will you be a candidate for any other scholarship this year. If yes, explain:
______
______
Name of parents or guardian: ______
Address of parents or guardian: ______
Number of brothers _____ Number of sisters _____
Father's Occupation ______
Mother's Occupation (if employed) ______
How many brothers and/or sisters will be attending college during the school year beginning this fall: ______
Explain your need for financial assistance: ______
______
______
Describe any employment you have had during the past two years including summer.
______
______
______
Record of 4H and/or FFA work:
Number of years enrolled ____ County ______
Kinds of projects: ______
______
Offices held: ______
Honors won in work: ______
Special activities in 4H and/or FFA work ______
______
Summarize other interests and activities (music, athletics, church work, camp, hobbies, etc.)
______
______
______
______
Statement indicating reasons for your decision to study in the field in which you have chosen:
______
______
______
______
______
Signature of Applicant ______
Signature of County Holstein Association Member:
______
Return by April 15th 2016 to:
UW Extension Office
412 W Kinne Street
PO Box 69
Ellsworth, WI 54011
F://4H-AGENT/Scholarships/2016