Riverview Scholarship Application

Please answer each of the following questions completely and to the best of your abilities. If you are not entirely truthful, Riverview will have no way of evaluating your qualifications. Any intentional falsification or misrepresentation of information is grounds for denial of the Scholarship. Applications will be accepted in both handwritten and computer-processed forms. Applications are due March 10, 2017 and should be mailedto: Riverview, Attn: Kevin Wulf, 26406 470th Avenue, Morris, MN 56267.

Name: ______Gender: M F

Last First

Address: ______

Address CityState Zip

Phone: (______) ______-______Cell Phone: (______) ______-______

Email Address: ______

Name of School:______Current GPA:______ACT Score:______

List the names of the colleges where you have applied

  1. ______3. ______
  2. ______4. ______

List the names of the colleges to which you have already been accepted

  1. ______3. ______
  2. ______4. ______

List the top three majors you plan to pursue in college and why

  1. ______
  2. ______
  3. ______

List any extracurricular high school activities in which you have been involved

______

______

______

List any awards you have received while in high school

______

______

______

______

______

______

Work History

List all jobs you have held in the last three years, including full- and part-time employment. Start with your most recent job first and then work back.

  1. Company Name and Address: ______

Dates: ______Pay: ______Reason for leaving: ______

  1. Company Name and Address: ______

Dates: ______Pay: ______Reason for leaving: ______

  1. Company Name and Address: ______

Dates: ______Pay: ______Reason for leaving: ______

Essay

Please type and attach a short (250-300 words), detailed essay about the following: Tell about a time when you were pressured to go against your values. What happened? How did you feel? How did you react? What lesson did you learn from the experience?

SIGNATURE: ______DATE: ______