Gate City Bank Community Scholarship Program

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Gate City Bank Community Scholarship Program “An Investment in our Communities”

Application Instructions

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Criteria

Gate City Bank, with 34 offices in 19 North Dakota and Minnesota communities, has been providing financial services for more than 85 years. As a community bank, Gate City Bank is committed to meeting various needs in each of our communities to help meet education needs.

Qualifications • Each applicant must be a high school senior attending school or residing in North Dakota or within 100 miles of a Gate City Bank location in Minnesota, and plan on attending college in the fall following their high school graduation.

The Gate City Bank Community Scholarship Program will award fortynine $1,200 scholarships to graduating seniors from high schools in North Dakota and Minnesota.

• The applicant must attend at least a two-year program at an accredited North Dakota, Minnesota, South Dakota, or Montana institution of higher learning (public or private).

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Selection

Selection Criteria taken into consideration will include, scholastic excellence, extra-curricular activities, community involvement, and financial need. Instructions: • Save this scholarship application to your computer. • When complete, print the application and submit it to your school counselor before the application deadline. Application Deadline: April 1, 2014.

• Gate City Bank employees and dependents of employees are not eligible for this scholarship.

Name______________________________________________________________________________________________________ Address___________________________________________________________________________________________________ City_ _________________________________________ County _________________ State _______ Zip Code ___________ Telephone _ _______________________________________________________________________________________________ Parent(s) or Guardian(s) __________________________________________________________________________________ Parent(s) or Guardian(s) address if different than students ______________________________________________ ___________________________________________________________________________________________________________ Name of high school______________________________________________________________________________________ Class Rank _____________ out of ______________ Cumulative GPA____________________________________________ College you plan to attend _______________________________________________________________________________ School Activities (include leadership roles or offices held and/or years of involvement): ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

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State how you have contributed your time and talents For a Better Way of Life® for yourself and your community. List any awards, recognitions and activities, leadership positions, number of years of participation, and number of hours spent. ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

Describe how Gate City Bank could affect your financial situation with a scholarship that would support you and your family For a Better Way of Life®. ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

Submit an essay of no more than 500 words on your educational and occupational goals that will offer you professional satisfaction For a Better Way of Life® in your future. Include what you have done or will do to help support the success of these goals. ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Important Items: • Should you be selected as a scholarship winner, you will need to furnish a senior photograph for use in advertising and news releases. • Should you be selected as a scholarship recipient, Gate City Bank will require you to obtain written consent from your parent/guardian to use your name and photograph in advertisements and in news release announcements • Scholarship funds are non-transferable to institutions outside of ND, SD, MN and MT. • If the total dollars you receive from all scholarships exceed the cost of tuition and books, the excess may be considered taxable income by the IRS.

M-37a (R 1/14)

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