Neosho County Farm Bureau Association
Neosho County Farm Bureau Association P O Box 154 Erie, KS 66733
215 S Main (620) 244-3431
DUE DATE: March 31, 2017 NOTE: Please complete application and ATTACH A COPY OF YOUR HIGH SCHOOL TRANSCRIPT, including your fall semester of your senior year. Please save, print and submit paper copy with signatures. STUDENT'S NAME STUDENT'S ADDRESS CITY
STATE
ZIP
TELEPHONE FATHER'S NAME MOTHER'S NAME GUARDIAN'S NAME (IF APPLICABLE) NEOSHO COUNTY FARM BUREAU MEMBERSHIP NUMBER
STUDENT'S SIGNATURE ___________________________________________________
PARENT / GUARDIAN SIGNATURE ________________________________________________ COLLEGE, UNIVERSITY, OR VO-TECH YOU PLAN TO ATTEND
SCHOOL(S) ATTENDED 1. HIGH SCHOOL CUMULATIVE GRADE POINT AVERAGE 2. ACT COMPOSITE SCORE PRINCIPAL'S SIGNATURE _________________________________________________ 1
SCHOOL ACTIVITIES
COMMUNITY ACTIVITIES
SUMMER OR PART-TIME WORK EXPERIENCES
2
PLEASE WRITE IN YOUR OWN WORDS (50 TO 250 WORDS), WHAT ARE MY PLANS FOR THE FUTURE?
3
215 S Main (620) 244-3431
DUE DATE: March 31, 2017 NOTE: Please complete application and ATTACH A COPY OF YOUR HIGH SCHOOL TRANSCRIPT, including your fall semester of your senior year. Please save, print and submit paper copy with signatures. STUDENT'S NAME STUDENT'S ADDRESS CITY
STATE
ZIP
TELEPHONE FATHER'S NAME MOTHER'S NAME GUARDIAN'S NAME (IF APPLICABLE) NEOSHO COUNTY FARM BUREAU MEMBERSHIP NUMBER
STUDENT'S SIGNATURE ___________________________________________________
PARENT / GUARDIAN SIGNATURE ________________________________________________ COLLEGE, UNIVERSITY, OR VO-TECH YOU PLAN TO ATTEND
SCHOOL(S) ATTENDED 1. HIGH SCHOOL CUMULATIVE GRADE POINT AVERAGE 2. ACT COMPOSITE SCORE PRINCIPAL'S SIGNATURE _________________________________________________ 1
SCHOOL ACTIVITIES
COMMUNITY ACTIVITIES
SUMMER OR PART-TIME WORK EXPERIENCES
2
PLEASE WRITE IN YOUR OWN WORDS (50 TO 250 WORDS), WHAT ARE MY PLANS FOR THE FUTURE?
3
