ALLIANCE PIPELINE SCHOLARSHIP
Administered by the Illinois Foundation FFA
1. Deadline for application is March 1. A March 1 postmark is acceptable.
2. The scholarship is available to any FFA member who is a senior at any of the 15 high schools in
the 6 Illinois counties the Alliance pipeline crosses as listed below:
Rock Island County – Rock Ridge
Whiteside County – Prophetstown
Bureau County – Bureau Valley and Princeton
LaSalle County – LaSalle-Peru, Mendota, Newark, Ottawa, Seneca, Serena and Streator Twp.
Grundy County – Minooka
Will County – Beecher, Lincoln-Way, Lockport and Peotone
3. Recipients may attend a two or a four year college.
4. Applicants will be judged on a combination of financial need; academic achievement; leadership;
and school, community and church involvement.
5. The scholarship selection committee will select the most qualified individuals for the
scholarships based on the selection criteria in number 4 above.
6. Five scholarships in the amount of $1,000 will be awarded annually for each of the next four years.
7. The scholarship will be paid in the fall directly to the college or university the recipients are
attending. It will be the responsibility of the scholarship recipients to provide the Illinois
Foundation FFA with:
1. Proof of enrollment at the two or four year college they are attending.
2. Information where the scholarship is to be mailed (office name and address).
3. Any necessary information such as student ID number, etc. in order for the scholarship
to be credited to their student account.
8. The application and all support materials should be mailed in one envelope to:
Illinois Foundation FFA
3221 Northfield Dr.
Springfield, IL 62702
Application for the
ALLIANCE PIPELINE SCHOLARSHIP
(Revised 1/08/09)
PERSONAL INFORMATION:
Name: _____________________________________________________
Address: ___________________________________________________________________________
City: ___________________________________ State: ____________ Zip Code: _______________
Date of Birth: ________________________________
Name of High School: ________________________________________________________________
Number of Years You Have Been an FFA Member: _____
Highest FFA Degree You Have Earned: __________________________________________________
My Supervised Agricultural Experience Program (SAEP) Included the Following (please list):
__________________________________________________________________________________
__________________________________________________________________________________
Your high school grade point: ________ on a ________ scale and class rank: ______of ______
Name of College/University you plan to attend: ____________________________________________
Address: ___________________________________________________________________________
City: ___________________________________ State: _____________ Zip Code: ______________
Major: ____________________________________________________________________________
What do you estimate your college expenses will be next year?
Tuition
$____________________
Books/Fees
$____________________
Room/Board $____________________
Other Costs
$ ____________________ (cost of fuel, etc. if commuting from home)
Total Cost
$____________________
FAMILY INFORMATION:
Father’s name: ____________________________ Mother’s name: ____________________________
Address: ___________________________________________________________________________
City: _____________________________________ State: __________ Zip Code: _______________
Father’s occupation: _________________________________________________________________
Mother’s occupation: _________________________________________________________________
How many brothers and sisters do you have? _____________
Will any of them be attending a college or university next year? ________________
If yes, list them by name, year in school, and name of college or university they will be attending:
FINANCIAL INFORMATION:
Parent’s annual income - Father: $____________________ Mother: $____________________
(Income information does help show financial need, but is not required should the applicant choose not to provide the
information)
Will you be receiving any other financial aid for school next year? ___________
If yes, list the type of aid (scholarship, grant, tuition wavier, etc.) and amount:
Please give any financial information not included above which you feel the selection committee
should know as they choose the scholarship recipients.
(2)
ACTIVITIES AND AWARDS:
List FFA and school activities you have been involved in during high school.
List community and/or church activities you have been involved in.
List FFA and other leadership positions you have held in your school, community, and church.
(3)
List awards you have received (FFA, academic, extracurricular, community, church, etc.)
CERTIFICATION:
We certify that all information contained in this application is accurate and correct to the best of our
knowledge.
Applicant’s signature: ____________________________________________ Date: ______________
Parent’s signature: _______________________________________________ Date: ______________
Advisor’s signature: ______________________________________________ Date: ______________
School official’s signature: ________________________________________ Date: ______________
School official’s title: (circle one)
Superintendent
Principal
Guidance Counselor
SUPPORT MATERIALS TO BE SUBMITTED WITH YOUR APPLICATION:
1. Copy of high school transcript.
2. Three letters of reference from people other than members of your family. Two of the letters
must be from school personnel. One letter must be from someone outside of school.
3. Applicant’s personal statement not to exceed one page that addresses the question “Why I
Should be Selected to Receive This Scholarship”. Please include goals and future plans.
Note: Applicants may attach an additional page if they need more space on page 3 & 4 of the
application. Please make sure you use the headings as they appear on pages 3 & 4 if you use an
additional page.
(4)