Name Address Phone number Father's name and ...
____________________________________________ Name
Address
Phone number
Father’s name and occupation
Mother’s name and occupation
Number of children living at home (including you)
Farm Bureau Membership #
Scholarship Application Blanco County Texas Farm Bureau
(NOTE: Applicant’s parents or guardian MUST have been a member of the Blanco County Farm Bureau for at least a year at the time of this application.)
SAT Score: Verbal __________ Math ___________ Total ___________ ACT Score: (COMP) __________ Rank in class: ____________________ Grade Point Average: ________________________
What College, University or Technical Institute do you plan to attend? ________________________________________________________________________________________ What is your intended Major or Field of Study?
Describe why you feel you deserve this scholarship: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
List any school related activities in which you participated, including honors received, offices held and the approximate time devoted to each activity outside school hours: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
Page 2
List in the same manner as above, any Non-School related organizations in which you have participated. These could include, but are not limited to, 4-H, Boy Scouts, Girl Scouts, church organizations and civic organizations: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
List any agriculture related work or jobs you have done, including, but not limited to 4-H and FFA and how long you have done them (EX: if you live on a ranch what are your chores): ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
Note: RETURN THIS APPLICATION TO THE BLANCO COUNTY FARM BUREAU OFFICE AT 63 N. MAIN ST. BLANCO, TX OR TO THE HIGH SCHOOL COUNSELOR’S OFFICE WHERE A FARM BUREAU REPRESENTATIVE WILL RETRIEVE THEM. APPLICATIONS MUST BE COMPLETED AND IN THE BLANCO COUNTY FARM BUREAU OFFICE BY MAY 1, 2017. (If the application is mailed to the Farm Bureau office it must reach there by May 1st)
Page 3 Student in Good Standing Certificate TO THE APPLICANT: Print your name and today’s date and forward this certification to the school office. You will need to read and understand the following statement before signing, as your signature represents your agreement for the school official to complete this portion of the application. When the certificate is complete, retrieve it and submit it with your application. I, the undersigned student, am seeking a scholarship from the Blanco County Farm Bureau and agree to the release of the following information as requested below. Student’s signature: _____________________________________________________________________ Date: _________________________________________________________________________________ TO THE SCHOOL OFFICIAL The above student is applying for a scholarship given by the Blanco County Farm Bureau. The scholarship committee would appreciate the completion of the following data. Number of days absent-to-date the current school year: _____________________________________ Records indicate that the student will probably graduate at the end of the current academic year, barring any unusual occurrence or mishap prior to graduation day: ________ Yes ________ No The student has passed all portions of the Texas Exit TAAS (TAKS) Test: ________ Yes ________ No Is there any disciplinary action pending against this student at this time? ________ Yes _________ No Has the student been referred to the office this year concerning a disciplinary natter? ______ Yes _____No If so and if the referral was not dismissed, please provide a short description of the offense: ________________________________________________________________________________________ ________________________________________________________________________________________
School Official’s signature ____________________________________________ Date _________________ Thank you for your time and assistance. Blanco County Farm Bureau
Address
Phone number
Father’s name and occupation
Mother’s name and occupation
Number of children living at home (including you)
Farm Bureau Membership #
Scholarship Application Blanco County Texas Farm Bureau
(NOTE: Applicant’s parents or guardian MUST have been a member of the Blanco County Farm Bureau for at least a year at the time of this application.)
SAT Score: Verbal __________ Math ___________ Total ___________ ACT Score: (COMP) __________ Rank in class: ____________________ Grade Point Average: ________________________
What College, University or Technical Institute do you plan to attend? ________________________________________________________________________________________ What is your intended Major or Field of Study?
Describe why you feel you deserve this scholarship: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
List any school related activities in which you participated, including honors received, offices held and the approximate time devoted to each activity outside school hours: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
Page 2
List in the same manner as above, any Non-School related organizations in which you have participated. These could include, but are not limited to, 4-H, Boy Scouts, Girl Scouts, church organizations and civic organizations: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
List any agriculture related work or jobs you have done, including, but not limited to 4-H and FFA and how long you have done them (EX: if you live on a ranch what are your chores): ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
Note: RETURN THIS APPLICATION TO THE BLANCO COUNTY FARM BUREAU OFFICE AT 63 N. MAIN ST. BLANCO, TX OR TO THE HIGH SCHOOL COUNSELOR’S OFFICE WHERE A FARM BUREAU REPRESENTATIVE WILL RETRIEVE THEM. APPLICATIONS MUST BE COMPLETED AND IN THE BLANCO COUNTY FARM BUREAU OFFICE BY MAY 1, 2017. (If the application is mailed to the Farm Bureau office it must reach there by May 1st)
Page 3 Student in Good Standing Certificate TO THE APPLICANT: Print your name and today’s date and forward this certification to the school office. You will need to read and understand the following statement before signing, as your signature represents your agreement for the school official to complete this portion of the application. When the certificate is complete, retrieve it and submit it with your application. I, the undersigned student, am seeking a scholarship from the Blanco County Farm Bureau and agree to the release of the following information as requested below. Student’s signature: _____________________________________________________________________ Date: _________________________________________________________________________________ TO THE SCHOOL OFFICIAL The above student is applying for a scholarship given by the Blanco County Farm Bureau. The scholarship committee would appreciate the completion of the following data. Number of days absent-to-date the current school year: _____________________________________ Records indicate that the student will probably graduate at the end of the current academic year, barring any unusual occurrence or mishap prior to graduation day: ________ Yes ________ No The student has passed all portions of the Texas Exit TAAS (TAKS) Test: ________ Yes ________ No Is there any disciplinary action pending against this student at this time? ________ Yes _________ No Has the student been referred to the office this year concerning a disciplinary natter? ______ Yes _____No If so and if the referral was not dismissed, please provide a short description of the offense: ________________________________________________________________________________________ ________________________________________________________________________________________
School Official’s signature ____________________________________________ Date _________________ Thank you for your time and assistance. Blanco County Farm Bureau
