TeacherWeb®

GPA ________________

** If you are unable to print this application, please send Deb an e-mail at

Klegin.deb@cannonfallsschools.com and she will e-mail you the application. CLASS RANK ________

You should be able to then open the application on your hard drive and

type your answers to the questions.

VERIFIED____________

(This portion will be filled out by the Guidance Office)

CANNON FALLS LOCAL SCHOLARSHIP APPLICATION

STUDENT'S NAME _______________________________________________________

Father/Guardian's Name ___________________________________________________

Occupation (Be specific - indicate what he does and where he works):

_______________________________________________________________________

Mother/Guardian's Name __________________________________________________

Occupation (Be specific - indicate what she does and where she works):

_______________________________________________________________________

LIST THE HIGH SCHOOL COURSES YOU HAVE TAKEN IN GRADES 11 AND 12:

GRADE 11

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

LIST ANY EXTRA CURRICULAR ACTIVITIES YOU WERE INVOLVED IN AND ANY HONORS OR SPECIAL RECOGNITION YOU HAVE RECEIVED. (You can add a separate attachment).

List both school/community and church activities/accomplishments.

LIST OF SCHOOL ACTIVITIES LIST GRADE YOU PARTICIPATED ACCOMPLISHMENTS

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

LIST COMMUNITY ACTIVITIES LIST GRADE YOU PARTICIPATED ACCOMPLISHMENTS

____________________________________________________________________________________

BRIEFLY DESCRIBE ANY PAID WORK EXPERIENCE:

Kind of Work Employer Date of Employment

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

(you can add an attachment)

PLEASE INDICATE ANY OTHER SOURCES OF FINANCIAL AID YOU HAVE ALREADY BEEN

AWARDED AND INTEND TO ACCEPT:

Amount: ________________ From Whom: ___________________________________________

HOW MANY BROTHERS AND SISTERS DO YOU HAVE? _______

HOW MANY ARE IN COLLEGE? ______ AND AT WHAT COLLEGE____________________________

IN HIGH SCHOOL? _____ IN ELEMENTARY SCHOOL? _____

HOW MANY ARE SELF-SUPPORTING? _____

PLEASE WRITE A DETAILED DESCRIPTION INCLUDING SPECIFIC INFORMATION ABOUT YOUR FUTURE EDUCATIONAL PLANS. MAKE SURE YOU INCLUDE THE NAME OF THE EDUCATIONAL INSTITUTION YOU PLAN TO ATTEND, YOUR INTENDED FIELD(S) OF STUDY AND THE LONG TERM GOALS YOU WOULD LIKE TO PURSUE AS A RESULT OF COMPLETING YOUR EDUCATION. ALSO EXPLAIN WHY YOU WOULD APPRECIATE A SCHOLARSHIP.

___________________________________________________________________________________

I UNDERSTAND THAT IF I DO NOT FULFILL THE GUIDELINES SET FORTH BY THE SCHOLARSHIP SELECTION COMMITTEE, I WILL FORFEIT/RETURN THE SCHOLARSHIP MONIES AWARDED TO ME. I ALSO AT THIS TIME GIVE CANNON FALLS HIGH SCHOOL PERMISSION TO RELEASE A COPY OF MY TRANSCRIPT THAT INCLUDES MY G.P.A. AND CLASS RANK, WHICH MAY BE USED BY THE SELECTION COMMITTEES, FOR CONSIDERATION OF THE CANNON FALLS SCHOLARSHIPS.

TO THE BEST OF MY KNOWLEDGE, ALL OF THE ABOVE INFORMATION IS CORRECT.

Please print this and take this application to Deb Klegin in the Guidance office.

STUDENT'S NAME_______________________________________DATE __________________

Student’s signature required

PLEASE SUBMIT THIS WITH YOUR SCHOLARSHIP APPLICATION

STUDENT'S NAME ________________________________________________

NAME(S) OF SCHOLARSHIP(S) APPLYING FOR:

Please make sure you meet the requirements as stated in the scholarship booklet.

________________________________________

________________________________________

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