Local Scholarship Application Form

2017 APPLICATION FORM

HORICON AREA SCHOLARSHIPS

LAST NAME: FIRST NAME: MI.: BIRTH DATE:

GPA ______(to be completed by Guidance Office)

MUST BE TYPEWRITTENApplications are due in the student services office Wednesday, March 15, 2017 by 3:15 pm

1.Give names of parents, as names should appear for newspaper article:

2.What field or course of study will you pursue in post-secondary school?

3.What post-secondary school do you plan to attend?

4.Have you been accepted at this institution?YES NO, not yet

If so, please attach a copy of the acceptance letter.

5.What is the estimated tuition cost per year of attending this institution?

6.Upon completion of educational training (college, technical college, etc), what are your career plans?

7.List any monetary awards or scholarships that you will be receiving that you already know about:

8.How many brothers and sisters are now in post-secondary school?

9.How many children are living at home, including you? What are their ages?

10.Are any of your parents or grandparents a veteran? YES NO

Name(s) WWII Korean War Vietnam War Grenada/Lebanon Panama Persian Gulf-Present

WWII Korean War Vietnam War Grenada/Lebanon Panama Persian Gulf-Present

11.Are any of your parents or grandparents a member of the Horicon Legion or Horicon Legion Auxiliary? YES NO

Name(s) WWII Korean War Vietnam War Grenada/Lebanon Panama Persian Gulf-Present

WWII Korean War Vietnam War Grenada/Lebanon Panama Persian Gulf-Present

Use the following dates as reference for #10 and #11:

World War II12/07/41 - 12/31/46Grenada/Lebanon08/24/82 - 07/31/84

Korean War06/25/50 - 01/31/55Panama12/20/89 - 01/31/90

Vietnam War12/22/61 - 05/07/75Persian Gulf1990-92 & Present

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12.Check extra-curricular and volunteer activities at each grade level, both school and community. Type in

any other activities not mentioned here, and click on the appropriate grade level box.

9 / 10 / 11 / 12
Future Farmers of America (FFA)
Music: Pep-Band (performance beyond requirements)
Instrumental Solo-Ensemble
Drum Major
Color Guard
Vocal Solo-Ensemble
Art Club
Student Council
Forensics
All School Musical
All School Play
Talent Show
Math Team
Academic Bowl
Badger Boys/Girls
Trees for Tomorrow
Business World
Future Business Leaders of America (F.B.L.A.)
Homecoming Committee
Prom Committee
Winterfest Committee
Athletics:Spirit Squad
Dance Team
Football
Basketball
Baseball
Softball
Wrestling
Track + Field
Golf
Volleyball
Cross Country
Boy – Girl Scouts
Church Groups
Sunday School Teacher or Nursery Volunteer
4-H
Salvation Army Bell Ringer
Kiwanis Swim Day Volunteer
Non-School Music
Non-School Theater
Blood Donor
Tri-Arts
Year Book
Family, Career and Community Leaders of America (FCCLA)
HHS Craft Fair

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13.List any offices, chairmanships, team captains, or other leadership positions you

held when you were participating in the activities listed in question #12.

9 / 10 / 11 / 12

14.List honors and awards that you have received while in high school. Examples: National Honor Society, Badger Boys or Girls State, Honor Roll, Athletic (MVP, Most Improved, etc.), Music (State Solo-Ensemble, Best Class Award, Most Improved, etc).

9 / 10 / 11 / 12

15.Employment. List your employment history for the last 4 years.

Position / Employer / Dates

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16. Describe your personal strengths and how you will use them to succeed in your post-secondary education.

17. What goals do you hope to achieve through your post-secondary education? (i.e. career)

18. Please add any additional information, which you feel, would be useful to the Scholarship Committee in evaluating your application.