Pleasant Prairie Woman’s Club

SCHOLARSHIP FOR PLEASANT PRAIRIE RESIDENTS

GFCW- Pleasant Prairie Woman’s Club

Pleasant Prairie, Wisconsin

PEARL RUFFOLO MEMORIAL SCHOLARSHIP APPLICATION

______

Date of Application

Name in Full:______

Last First Middle

Home Address:______Phone:______

Place of Birth:______Date of Birth:______

(mm/dd/yyyy)

Father’s/Guardian’s Full Name:______

Father’s/Guardian’s Employer:______Occupation:______

Mother’s/Guardian’s Full Name______

Mother’s/Guardian’s Employer:______Occupation:______

Do you reside with your parents, if not with whom? Y/N______

Number of children in your family: Brothers:____Ages:______

Sisters:______Ages:______

What work have you done throughout the school year and during summers?______

______

Have you saved any money?______

If you were not employed during the summers, how did you spend that time?______

______

Plans for financing your future education/training:

a. Amount you have saved for future education: $______

b. Amount you can expect from parents or other sources: $______

Class Rank:______ SAT Score:______ACT Score:______

Current High School Attending:______

Name of the school in which you plan to enroll:______

Where is this school located? ______

Date of entrance?______

What profession have you chosen? Please explain your reasons for choosing this profession:______

ACTIVITIES

List the student activities in which you have participated during high school:

______

In what community activities have you participated?______

______

Add any information you think will be useful to the scholarship committee in evaluating your application:______

ü  Your high school transcripts need to be included with this application.

ü  A letter of recommendation from a responsible citizen who knows you well, such as; a principal, guidance counselor, teacher, clergy person, or club member should accompany this application.

If I am awarded this scholarship, I will make every effort to complete the prescribed course of study.

Applicant’s Signature:______Date:______

Parent or Guardian’s Signature:______Date:______

(not needed if applicant is over 18 at time of signing)

APPLICATION DEADLINE is MARCH 31, 2015

Mail to: Mrs. Kathleen Ladousa

5313 Springbrook Road

Pleasant Prairie, WI 53158

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