Pierce & Pepin County Holstein Association

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