SCHOLARSHIP APPLICATION

PO BOX 2736
Great Falls, Montana 59403
1. Last Name First Middle
2. Address
3. City State ZipCode
4. Home Telephone Birthdate Birthplace
5. HS Counselor & Telephone Number
6. Name and Address of High School and/or College(s) you have attended Dates Attended Major Field or Degree GPA
7. ACT Composite Score Date Test Taken    
   
8. SAT Composite Score Date Test Taken    
   
9. Name and Address of College/University you will attend next year
10. What major field of study will you pursue   Class status (F, So, J, Sr)  
   
11. Describe your school activity participation
Name of Activity
Describe Responsibility/Involvement
12. Describe your community service participation
13. Describe any school or community leadership roles you have experienced and any honors you have received.
14. Personal History
 
Applicant
Father
Mother
Name      
Address      
Employer      
Job Title      
15. Please provide the names and ages of any siblings
 
16. Enter your personal statement using 300 words or less:
 
17. Authorization

  • Federal regulation require us to obtain permission from the awarded persons for release of academic and biographical information to the scholarship donor and/or news media. By signing below, I agree that relevant information may be released.
  • I will provide a photo for use with media releases. (This photo will be returned to the applicant later in the year. Please print your name on the back side of the photo).
  • Further, by signing below, I confirm the accuracy of the enclosed information and understand that any false or misleading statements may invalidate my application.

    Please note: When you SAVE this application it will ask for a Password which will allow you to access this submission for editing or printing at anytime you wish, up until the application deadline.