Scholarship Application

First Name

Home Address

Telephone & Email

Parents or Guardians Names/ Telephone Numbers

Achievements in Academic, Extracurricular or Community Involvement.

If applicable, describe your agricultural experience and/or job experience and how it has helped you develop.

Name of School and Program you expect to attend after graduation.

Have you been accepted as of today?

Yes

Cumulative High School GPA

Tell us why you chose a future as a diesel/Ag equipment technician. Please tell us why we should choose you.

I understand the selection process and acknowledge that any misrepresentation of facts on this application will be cause for disqualification.

Yes

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