MARY PETZEL MEMORIAL SCHOLARSHIP
SCHOLARSHIP APPLICATION
Eligibility:
The Mary Petzel Memorial Scholarship is made available to any immediate
member of a Marion County Farm Bureau family preparing to enter a junior
college, or a four-year college or university in the State of Oregon in an
agricultural-related major.
Instructions:
This application must be completed in full and postmarked on or before July1 to be
considered by the Selection Committee. Applications postmarked after July 1 are considered
ineligible.
A transcript of each high school, junior college and college attended, must accompany this
application. Transcripts should be sealed by registrar and accompany this application
unopened. Three letters of recommendation must also be sent with the application.
1.
Name in full __________________________________________________________
First
Middle
Last
2.
Social Security Number ________________________________________________
3.
Home Mailing Address _________________________________________________
street/route and box #
city
____________________________________________________________________
state
zip
county
how long
telephone
4.
______________________________
father’s name in full
________________________________
mother’s name in full
5.
______________________________
father’s occupation
________________________________
mother’s occupation
6.
If married, give full name of spouse _______________________________________
7.
Local newspaper _____________________________________________________
8.
College/University ____________________________________________________
9.
Applying to enter:
10.
Major _______________________________________________________________
11.
Occupation you are preparing for _________________________________________
12.
Did you grow up on a farm?
Yes
No
_____ acres
13.
Did you work on a farm?
Yes
No
_____acres
14.
Write a brief description of your past agricultural experiences. (On additional page)
15.
Please describe your work experience and list one work reference. (On additional
page)
16.
For the career in which you are preparing, what steps are necessary to attain that goal
and how have you prepared and plan to complete this goal? (On additional page)
17.
List your involvement in community activities and service:
_________________________________
_____________________________
_________________________________
_____________________________
_________________________________
_____________________________
18.
List your most significant leadership activities:
_________________________________
_____________________________
_________________________________
_____________________________
_________________________________
_____________________________
19.
List school activities, citizenship and scholastic awards/honors/recognition:
_________________________________
_____________________________
_________________________________
_____________________________
_________________________________
_____________________________
_________________________________
_____________________________
_________________________________
_____________________________
20.
List high schools, junior colleges and colleges/universities attended, dates of
attendance and graduation (including your present school). Do not include single
course or class studies, e.g. night school:
Fall
Winter
Spring
Summer
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
BE CERTAIN YOUR TRANSCRIPTS ARE INCLUDED WITH THIS APPLICATION
21.
Applicant’s overall GPA from high school ____, Jr. College ____, College ____
22.
Class ranking _____ out of _____.
23.
What will be your college standing this coming September?
Freshman ( ) Sophomore ( ) Junior ( ) Senior ( ) or Graduate ( )
24.
How did you find out about this scholarship?
_____________________________________________________________________
25.
Have you been or are you now the beneficiary of a scholarship or another award? If
so, give names and amounts.
____________________________________________________________________
____________________________________________________________________
26.
Have you received the Mary Petzel Memorial Scholarship in the past? If so, please
indicate which year: ___________________________________________________
27.
Will you work while attending college? ____________________________________
____________________________________________________________________
28.
LETTERS OF RECOMMENDATION:
Applicant must submit three letters of
recommendation, giving information about his/her character, ability, and community
service. These must be filed and sent with the scholarship application.
The names and occupations of the persons (relatives excluded) writing the letters:
1.
_____________________________________________________________
2.
_____________________________________________________________
3.
_____________________________________________________________
29.
How do you plan to be involved on campus and in the community in which you will
be living?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
30.
write a short biography including reasons for your
choice of major subject and what your plans are for the future. This may be
continued on an additional page.
IN YOUR OWN HANDWRITING,
Applicant certifies that the above information is true. Applicant agrees that if applicant is selected for a
scholarship, applicant will attend in the institution listed above and will pursue the major course of study
listed above for the duration of the academic year listed above. Applicant understands and agrees that
failure to comply with the above may render applicant ineligible for the scholarship granted and applicant
may be required to return any remaining portions of the scholarship award to Marion County Farm
Bureau’s Scholarship Selection Committee. Upon completion of each portion of the academic year in
question, applicant shall supply the Scholarship Selection Committee with a complete transcript.
Dated this __________ day of ________________, 20___.
_______________________________________
Applicant’s signature