IMPORTANT: MAY 15th DEADLINE
ANSWER ALL QUESTIONS 1-16 & COMPLETE PAGE FOUR
Eldon E. Witt
Agriculture Education Scholarship
Administered by
THE ELDON E. WITT AGRICULTURE EDUCATION SCHOLARSHIP FUND
c/o IAVAT
3221 Northfield Drive
Springfield, Illinois 62702
IMPORTANT: Application must be postmarked no later than MAY 15th
Information in this application will be treated as confidential.
MANDATORY - Attach copy of High School and College transcript, ACT Scores & Photo.
Application For Assistance
To be filled out by student with help of college agriculture advisor.
Applications must be postmarked no later than May 15th, and sent to the IAVAT State Office, 3221
Northfield Drive, Springfield, Illinois 62702. Late applications will not be accepted.
A.
The thrust of the Eldon E. Witt Agriculture Education Scholarship Program is geared toward the
Agriculture Education Profession. Although the program has many target areas, the main target of
this program and application is geared toward a College Student in the Agriculture Education
Curriculum at one of the four major agriculture colleges in Illinois. The scholarship is to be used to
help fund the recipients expenses during his/her semester of student teaching. Applicants are limited
to College Juniors Only.
B.
Currently, due to economic restraints of the agriculture education students, the majority of them take
their student teaching training at schools near the university that they are currently enrolled, thus
narrowing the base of excellent programs from which they could choose from. This scholarship of
$750 - $1,000, it is hoped, will allow the students to take their student teacher training at more of the
top schools throughout the state.
C.
Following the receipt of this application the Eldon E. Witt Agriculture Education Scholarship Board of
Trustees will give careful consideration to all applications and determine the applicant to receive the
scholarship. All applicants will be notified on or about June 10th. Decisions of the Board of Trustees
will be final.
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ANSWERS MUST BE IN LEGIBLE WRITING WITH PEN
AND INK OR TYPEWRITTEN. (Please do not tear or make
additional folds in this application. Use only space provided.)
PHOTO
(Applicant will please attach
small Black & White picture taken
within the last 6 months.)
1.
Last Name
First Name
Middle Name
______________________________________________
2.
Mailing address (Number, Street, City, State, Zip Code)
School:________________________________________
___________________Telephone No._______________
Permanent:____________________________________
___________________Telephone No._______________
3. Name and address of local Newspaper:_______________________________________________
_______________________________________________________________________________
4. Age
5. Date of Birth
6. Sex
___
__________
___
9.
7. Social Security No.
________________
8. High School Graduation Date
_______________________
What High School Did You Attend? ________________________________________________
Located at (Address)
___________________________________________________________
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10. List your class, extra-curricular activities and special recognitions including athletics or hobbies in
which you have participated in high school, church or community. Indicate which years and how many
years.
a. High School: School: _________________________________________________________
________________________________________________________________
________________________________________________________________
Community: ______________________________________________________
________________________________________________________________
________________________________________________________________
Ag Related: ______________________________________________________
________________________________________________________________
________________________________________________________________
b. College:
School: __________________________________________________________
________________________________________________________________
________________________________________________________________
Community: ______________________________________________________
________________________________________________________________
________________________________________________________________
Ag Related: ______________________________________________________
________________________________________________________________
________________________________________________________________
11. What excites you about the Agriculture Education Profession to make you choose this as a
career?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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12. I. FUNDS AVAILABLE FOR
SEMESTER OF STUDENT
TEACHING
II. ESTIMATED EXPENSES FOR
SEMESTER OF STUDENT
TEACHING
A. From Savings
$_______
A. Tuition
$_______
B. From Earnings
$_______
B. Board & Room
$_______
I.
Funds Available
$_______
II. Estimated Expenses
C. From Parents
$_______
D. From other loans $_______
& scholarships
TOTAL
C. Books
$_______
D. Clothes
$_______
E. Travel
$_______
F. Other
$_______
TOTAL
$_______
$_______
Estimated Money
Needed
$_______
$______
13. What employment have you held in the past two years?_________________________________
______________________________________________________________________________
______________________________________________________________________________
14. What is your philosophy concerning the responsibilities of your future students to Illinois
Agriculture?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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STATEMENT OF APPLICANT:
A. I affirm that I will complete my student teaching experience during the _____ semester of the
2004-2005 school year.
B. In the event that I am granted the scholarship, I hereby certify that I intend to actively pursue a
career as an Agriculture Teacher in the Public School System in Illinois.
C. In the event of receiving the scholarship, I agree to provide the Eldon E. Witt Agriculture
Education Scholarship Board of Trustees a written or personal report of my student teaching
experience and the adequacy of the scholarship funds received.
D. I affirm that the information given in the foregoing application is true and correct.
__________________________________
Tel. No. - include Area Code
_____________________________________
Signature of Applicant
16. STATEMENT OF COLLEGE AGRICULTURE ADVISOR:
As the College Agriculture Advisor of the above applicant, I guarantee that the above applicant will,
in the event of their selection to receive this scholarship and upon completion of their student
teaching experience, will provide to the Eldon E. Witt Agriculture Education Scholarship Board of
Trustees a written or personal report of their student teaching experience and the adequacy of the
scholarship funds received.
I have read the foregoing application and statements in full and, to the best of my knowledge, the
information is true and accurate.
_________________________________________
*Signature of College Agriculture Advisor
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