2018 BOETTIGER SCHOLARSHIP APPLICATION

The Emma D. Boettiger Scholarship Fund provides two scholarships for high school students from the city of Sheboygan to attend a campus of the University of Wisconsin System. Each scholarship is a one-time award of $1,000 (in two disbursements – $500 for fall semester and $500 for spring semester). The scholarships are given in the memory of Emma Boettiger's sister Nettie Dieckmann and nephew Freddie Dieckmann. There is a preference that one recipient plans to major in nursing; however, that is not a requirement. The applicant's overall scholastic record and evidence of financial need will be given primary consideration.

Applicants should plan to submit the Free Application for Federal Student Aid (FAFSA) before completing this application form. This form requires the student’s Estimated Family Contribution (EFC), which he or she will receive as a result of submitting the FAFSA.

Recipients of the Boettiger Scholarship must be enrolled full-time students at a University of Wisconsin System institution by the fall semester following high school graduation.

NAME:First: ______Middle: ______Last: ______

ADDRESS:Street: ______

City: ______State: ______Zip Code: ______

E-MAIL ADDRESS:______

AREA CODE &

PHONE NUMBER:______

CAMPUS YOU PLAN

TO ATTEND:University of Wisconsin - ______

INTENDED MAJOR:______

WORK EXPERIENCE

(Include dates of employment):______From: ______To: ______

______From: ______To: ______

______From: ______To: ______

______From: ______To: ______

______From: ______To: ______

ACTIVITIES & AWARDS: Please attach a list of activities, beginning with grade 9, in which you have been a significant

participant. Include honors or awards you may have received.

STUDENT STATEMENT: Attach a statement describing as completely and convincingly as possible why you should receive the Boettiger Scholarship. Describe your educational and career goals as well as previous experiences that have been particularly significant in your personal development.

2018BOETTIGER SCHOLARSHIP APPLICATION

FINANCIAL INFORMATION

Estimated Family Contribution (EFC) from the Free Application for Federal Student Aid (FAFSA): ______

Please explain any unusual family expenses or special financial obligations that the scholarship committee should be aware of:

2018 BOETTIGER SCHOLARSHIP APPLICATION

AUTHORIZATION FORM

Return the completed application to your guidance/counseling office by the deadline announced by your high school. The applicationand required supporting documents are due to the UW System scholarship committee no later than April 6, 2018.

Authorization is granted to my high school to release this application, as well as my high school transcript and test scores to the Boettiger Scholarship Committee.

STUDENT NAME:______

STUDENT SIGNATURE:______

DATE:______

SCHOOL COUNSELOR:

Forward all pages of this scholarship application, student transcript (copies are acceptable) reflecting seven semesters of high school work, andACT/ SAT test scores (copies are acceptable) to Randy Parvin at the address identified at the bottom of this page. Please provide cumulative grade point average and rank in class information below.

CUMULATIVE GRADE

POINT AVERAGE: ______

RANK IN CLASS: ______

COUNSELOR'S SIGNATURE: ______

Questions regarding the Boettiger Scholarships may be directed to:

Randy Parvin

UW HELP

5602 Research Park Blvd. Suite 300

Madison, WI 53719-1245

(800) 442-6459