APPLICATION FORM
LINCOLN COUNTY FARM BUREAU ACADEMIC SCHOLARSHIP
1. DATE: _________________
- NAME: _____________________________________________ AGE: _________
- ADDRESS: _________________________________________________________
- PHONE: ____________________ SOCIAL SECURITY #___________________
- NAME OF LINCOLN COUNTY FARM BUREAU MEMBER IN FAMILY:
ADDRESS AND PHONE NUMBER (IF DIFFERENT FROM ITEMS 3 & 4):
___________________________________________________________________
DATE OF MEMBERSHIP:
___________________________________________________________________
- EDUCATIONAL STATUS (CIRCLE APPROPRIATE RESPONSE):
- FINANCIAL AID:
A. HAVE YOU APPLIED OR DO YOU INTEND TO APPLY FOR FINANCIAL AID IN ORDER TO PURSUE THIS DEGREE? YES OR NO
B. DO YOU CURRENTLY OR PLAN TO HAVE EXTRACURRICULAR EMPLOYMENT IN ORDER TO PURSUE THIS DEGREE? YES OR NO
PLEASE CAREFULLY READ THE ACCOMPANYING INSTRUCTIONS FOR COMPLETION OF THIS APPLICATION. THE INSTRUCTIONS ALSO DETAIL THE CRITERIA FOR SELECTION. WE WISH YOU THE BEST!
YOUR APPLICATION PACKAGE SHOULD BE DELIVERED OR MAILED BY MARCH 30, 2010 TO:
LINCOLN COUNTY FARM BUREAU
ATTENTION: SCHOLARSHIP COMMITTEE
1114 MAIN STREET, P.O. BOX 424
LIMON, COLORADO 80828