DOC & BONNIE BENDER SCHOLARSHIP APPLICATION

Name:______

Address:______Phone:______

______E-Mail:______

  1. Academic Information and Verification. Please attach a copy of your transcript through the most recent December verified by your principal or guidance counselor.
  2. School Activities. List student activities in which you have participated during grades 9-12 and “X” the appropriate grade level(s). List leadership positions held and accomplishments and “X” the appropriate grade level(s). Limit your response to the space provided – one entry per line.

Student Activities / 9 / 10 / 11 / 12 / Leadership Positions/Accomplishment / 9 / 10 / 11 / 12
  1. Non-School Activities. List non-school leadership positions and community involvement and “X” the appropriate grade level(s). Also indicate the hours per week. Limit your response to the space provided – one entry per line.

Non School Activities / 9 / 10 / 11 / 12 / Level of Involvement/Leadership Positions/Accomplishments / 9 / 10 / 11 / 12
  1. Jobs. List any jobs you have held during the school year during grades 9-12 and “X” the appropriate grade level(s). Also indicate the hours per week. Limit your response to the space provided – one entry per line.

Jobs / 9 / 10 / 11 / 12 / Employment Positions/Hours Worked / 9 / 10 / 11 / 12
  1. Special Recognition. List special recognition, awards and honors received during grades 9-12 and “X” the appropriate grade level(s). List commendations not previously listed. Limit your response to the space provided – one entry per line.

Special Recognition, Awards, Honors / 9 / 10 / 11 / 12 / Group or Activity / 9 / 10 / 11 / 12
  1. College Funding. Please identify your anticipated sources of funding your college education by completing the following.

SourcePercentage of Funding

Personal Savings_____

Student Loans_____

Parents or other relatives_____

Scholarships_____

Earnings while attending college_____

Other (briefly identify)______

______

Total:100%

  1. Please identify where you plan to attend college and your anticipated major of study.

______

______

References:Please list two members of the high school faculty or administration as references. Give your reference authority to discuss your Application with members of the Doc and Bonnie Bender Scholarship Committee.

1.______

2.______

Doc and Bonnie Bender Scholarship Application Essay:

Briefly describe your educational goals and your plans following graduation.

______

I understand that news about scholarship recipients will be released to the local media. This includes names of scholarship recipients, parents’ names, and educational pursuits planned after high school graduation.

I certify that the above statement of information is correct to the best of my knowledge and belief.

______

Signature of Applicant

______

Date