CHEYENNE COUNTY SCHOLARSHIP APPLICATION
FACTUAL BACKGROUND

1.	Name of Applicant

2.	Address

3.	Telephone Number

4.	Parents’ or Guardians’ Names

5.	Address and Telephone Number (if different from above)

6.	Occupation of Parents or Guardians

7.	Month and Year Applicant will Graduate from Cheyenne County High School (Attach an official copy of your transcript through seven semesters of high school) ______________

8.	If you have attended schools other than the Cheyenne County School from which you will graduate, please list them below:

Name of School			Location			Yrs. Attended

9.	Fill in the blanks below to indicate your plans for further education beyond high school:

I plan to enroll at (name and location of institution)_______________________ 

in (month and year) ___________  to study in the field of (subject area) 

__________________

CERTIFICATION STATEMENT

Please read and sign the following statement after completing the application.

“I certify that, to the best of my knowledge and belief, all information contained in this scholarship application is accurate, true, and complete”

_______________________________________
Signature of Applicant

_______________________________________
Date of Application
1.	
In the space below, write a paragraph or more aimed at convincing the Scholarship Committee that you have demonstrated academic success in your past schooling and that you will be academically successful in future schooling. You might want to include details such as grade-point average, ACT test scores, academic honors received, etc.; but the details you include are up to you. Remember: Your purpose is to persuade.

2.	In the space below write a paragraph or more summarizing your plans for the future. You might want to include details such as your career plans, what you have done so far (and what still needs to be done) to prepare for that career, etc.; comments on plans other than career plans are also appropriate, if you care to include them. Remember: Your purpose is to inform.

3.	In the space below, write a paragraph or more aimed at convincing the Scholarship Committee that you need financial assistance in order to continue your education beyond high school. You might want to include details such as your parents’ or guardians’ income level and financial obligations, your own income level (if any), other scholarships or other financial assistance that you might receive, etc.; but the details you include are up to you. Remember: Your purpose is to persuade.

4.	In #1, you related your academic honors and achievements. Now write a paragraph or more summarizing your citizenship and contributions to your school, community, etc. through extra curricular activities and honors. You might want to include any other unusual or miscellaneous information about your background and/or your plans that you believe the Scholarship committee should know about.