LAKE COUNTY FARM BUREAU

70 US HIGHWAY 45

GRAYSLAKE IL 60030

AITC SCHOLARSHIP

APPLICATION FORM

GENERAL REQUIREMENTS FOR APPLICANTS FOR SCHOLARSHIP

1. Complete transcript of high school and any college course credit which has been completed

2. Scores of College Board Examination and/or other standardized test (ACT, SAT)

3. Completion of application form in detail

4. Possible interview with scholarship committee

5. Payment of monies for scholarship will be made directly to school when applicant has

been accepted and admitted. It may be used for tuition, fees and related academic expenses or room and board after any other scholarship money has been applied

SPECIFIC REQUIREMENTS FOR SCHOLARSHIP

1. MUST have a Course of study in agriculture or a related field

2. Applicants or parents/guardians must be residents of Lake County, IL

3. Applicant must be a member, or be the son or daughter of a Farm Bureau member, with an active membership for at least two years

4. Students are not eligible for this scholarship if they have received any other LCFB Scholarships in the past

INSTRUCTIONS

1. Complete personal history form

2. Give recommendation blank to proper school officials

3. All material must be returned to the Scholarship Committee by May 1, 2016 to be considered

LAKE COUNTY FARM BUREAU

70 SOUTH HIGHWAY 45

GRAYSLAKE IL 60030

AITC SCHOLARSHIP

RECOMMENDATION FORM: To be filled out by High School Principal or Counselor, College Registrar, Dean or Counselor

Applicant: Name ______

Address ______

City State Zip Code ______

Phone Number ______

Does this student have the potential for completing college work? ______

Does he/she have the aptitude for his chosen field? ______

In your opinion is applicant a worthy recipient of this scholarship? ______

Has student been a good citizen? ______

Please comment: ______

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Does applicant have your unqualified endorsement? ______

If not, why? ______

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Use this space to answer any questions more fully and to list and explain any additional information you feel the Committee should have to properly appraise the merit of this applicant

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Signature ______

School ______

Title Date ______

APPLICANT’S PERSONAL HISTORY

Date of birth Place of birth ______

Social Security number Farm Bureau number ______

Lake County resident? Number of years ______

Parents’ names ______

Name of school now attending ______

Address ______City/State/Zip ______

Year in school: High School Senior _____

College Freshman Sophomore Junior Senior

APPLICANT’S FINANCIAL SITUATION

Assets: Savings, investments, etc $ ______

Debts: College and/or other $ ______

Estimated employment while in college: Hours/week

Earnings/month $ ______

EMPLOYMENT

Describe any part time employment, during school, summer or other ______

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How much was earned during the last two years? ______

Present employer: Name ______

Address ______

Type of work and responsibilities ______

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EDUCATIONAL PLANS

College or school you plan to attend:

Name ______

Address ______

City State Zip Code ______

Have you been accepted at above named school? ______

Counselor’s name ______

Tuition Account number______

Anticipated expenses for next school year:

Tuition $ Fees and academic expenses $ ______

Room and board $ Other $ ______

Educational goal ______

Do you expect to go to college full time or part time? ______

If part time, what percentage? ______

State your reasons why ______

ACADEMIC QUALIFICATIONS

High school rank In a class of ______

High school grade point average ______

College grade point average ______

Awards, honors, other recognition received in the past two years ______

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List other scholarships you have applied for and their value ______

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Have any monetary scholarships or grants been awarded to you at the present time?

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If yes, indicate value and name of grant or scholarship ______

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State reasons you desire to study in the field you have chosen and any other factors you feel important to the Committee in considering your qualifications for a scholarship

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ENDORSEMENTS I hereby state that the above information is complete and correct and fulfills the requirements for this scholarship.

______Signature of Applicant Date

I have read his application as completed and to the best of my knowledge and beliefs, the information is complete and correct

______Signature of Parent or Guardian Date