Jeremiah “Jay” Tennessen Memorial Foundation

Scholarship Application

The Jeremiah “Jay” Tennessen Memorial Foundation has established a scholarship program for Tri-Valley high School Seniors who will attend any post-secondary institution. This scholarship was created in memory of Jay Tennessen, a 2005 graduate of Tri-ValleyHigh School. Jay was a gifted young man who showed great courage, integrity and perseverance while battling leukemia, which eventually claimed his life.

The award will be non-renewable and will range from $500-$1,500. The scholarship will be paid to the student and a post-secondary institution. Awards will be based solely on merit with financial need not a criterion and will be awarded on the basis of the following:

*Leadership

*Character

*Personal achievement

To qualify, students should be well rounded, determined to do their personal best, and have demonstrated achievement and ability to overcome personal hardship.

INSTRUCTIONS FOR SUBMITTING SCHOLARSHIP APPLICATION

  1. Complete all information on the scholarship application.
  2. Type or print all information
  3. Type a one (1) page essay that discusses the qualities that are mentioned in the Scholarship overview.
  4. Three (3) references; one (1) from a Teacher, Coach, Counselor. One (1) from a Pastor or Community member and one (1) personal.

***Deadline for applications is April 30th

Mail application, essay and references to:

Jeremiah “Jay” Tennessen Memorial Foundation

PO Box 114

Lyons, SD 57041

Notification will be sent to the recipients by mail

Jeremiah “Jay” Tennessen Memorial Foundation

Scholarship Application

Personal Information

Social Security Number: ______

Name Date of Birth Gender

Home Address

City State Zip Code

Name of Parent(s) or Guardian(s)

Education Record

High School GPA Date Graduated

College/University/Secondary School planning to attend

MajorMinor

List of activities in which you participated at school:

List interests and activities outside of school:

List awards and honors that you have received:

Signature

I affirm that all the information herein and provided with this application is true and correct.

SignatureDate

Parent(s) or Guardian(s) Signature Date