|ADNA SCHOLARSHIP FOUNDATOIN – SCHOLARSHIP APPLICATION
ADNA HIGH SCHOOL CLASS OF 2016
Last Name First Middle
Address (Street) (City) (State) (Zip)
Date of Birth Telephone Number E-mail Address
Where will you be attending school Fall 2016?
Name of Institution
Have you sent in your application?
Have you been accepted?
College/Voc Tech Student ID Number (You will receive a student ID number when you apply/are accepted. If you do not have your ID at this time, please give it to Mrs. Gale as soon as you receive it. Your ID is necessary in order to process any scholarship money you are awarded.)
Read carefully and sign:
If selected for a scholarship, I agree to send a thank you letter to my scholarship source. I understand that the scholarship money will be awarded to me and to the institution that I am attending after I verify my registration. I also understand that the scholarship award is for use in the 2016-17 school year only, unless I make a written request to the Adna Scholarship Foundation within 6 months of my graduation to delay the use of my award. This must be for a substantial reason and must be approved by the ASF Board.
I authorize the release of my educational records and this application form for scholarship purposes. Records may be released in a personally identifiable form to other parties associated with the Adna Scholarship Foundation program.
Applicant’s Signature________________________________________ Date:_______________
Adna Scholarship Foundation complies with all federal and state rules and regulations and does not discriminate on the basis of race, color, national origin, sexual orientation/gender identity or disability.
*****Your completed application must be turned in to Mr. Salme before your first period class on Friday, April 01, 2016. LATE APPLICATIONS WILL NOT BE ACCEPTED. NO EXCEPTIONS!
**Your responses must be typed. You may use this form for your application or you may use the computer to generate your own. Be sure to use the same headings and be sure to attach the signature page.
Give the following information for grades 9 – 12 only:
Accumulative GPA through 7 semesters (Include Transcript):
School/Community Honors and Awards:
Offices and Positions of Leadership:
Work Experience and/or Family Responsibilities:
Write about your educational and career goals, how you plan to achieve these goals and the reasons why you have chosen them.
Write about your financial need for a scholarship and anything else that you think will help the Scholarship Committee understand why you are deserving of an award.
As the next page, please attach a copy of your autobiography. This will help the people who select the recipients of the various scholarships know you on a more personal level than the application allows.