APPLICATION
FOR
EMMA
SKOGEN SCHOLARSHIP FUND
(Please type or print clearly in black ink.)
1. ______________________________________________________________________
Last or Family Name First Middle
2. Female ____ Male ____
Age ___________ Birth Date ___________
3. Permanent Address (street, city, state,
postal code)
___________________________________________________
___________________________________________________
Tel. (
) ________________________
4. Address to which correspondence should be
sent (if different from above):
___________________________________________________
___________________________________________________
Tel. (
)________________________
The criteria by which the candidates are
evaluated are:
1) Financial need
(Describe and give as much detail as possible when you indicate cost of program
with your ability to pay.)
2) Statement of
education and career goals
3) Involvement in
school and community activities
4) Other, e.g.,
work experience.
5. Please complete the following information
requested (attach extra sheet of paper, if necessary) and attach:
a) An official
copy of your latest grade transcript,
b) A letter of
recommendation (written by teacher, youth leader) describing your character and
abilities.
6. A) I plan to study:
________________________________________________________________________at
________________________________________________________________________School
Address
________________________________________________________________________
b) My long-term career goals are:
________________________________________________________________________________________________________________________________________________________________________________________________________________________
c) I have been actively involved in the
following school and community activities:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
d) Financial need must be stated:
Cost of Program: $________________
Ability to Pay: $________________
Gap to be made up: $________________
Comments (Describe and give as much detail
as possible):
________________________________________________________________________________________________________________________________________________________________________________________________________________________7.
My cumulative grade point average:
High School Grade Point Average:
______________
College Grade Point Average: _______________
If you are on a scale other than 4.0, please
indicate: ______________
8. I am currently working: ____ Yes ____ No
I am planning to work while pursuing my
studies: ____ Yes ____ No
9. Comments:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Date:__________________________
Signature:
_______________________________________________
Application
Deadline: Postmarked by March 15th of each year
