SOIL AND WATER CONSERVATION SOCIETY
KY BLUEGRASS CHAPTER
& BAILEY-ZIMMERMAN
SCHOLARSHIP APPLICATION
1. Name ___________________________________________________________
2. Present address and phone number
Address ____________________________________________________________
Phone ( ) _________________________(Cell #)____________E-mail ____________
3. Name and address of parent or guardian
___________________________________________________________________
Address
4. Occupation of parents or guardian
___________________________________________________________________
5. Date and place of birth
___________________________________________________________________
6. Married ____ yes ____ no
If yes give spouse's name
___________________________________________________________________
Spouse's occupation
___________________________________________________________________
7. List names and ages of dependent children _____________________________
________________________________________________________________
8. Other aid being received (grants, scholarships, etc.)
____ yes ____ no What kind?
___________________________________________________________________
9. High School attended
___________________________________________________________________
Year graduated ____________________________________________________
10. What year are you in college?
___________________________________________________________________
11. What is your major course of study?
___________________________________________________________________
12. What percentages of your funds for college have come
from: parents ____%, summer and part-time work ____%,
loans ____%, scholarships ____%, other ____%.
13. List employment history:
Employer ___________________________________________________________
Dates ______________________________________________________________
Brief description of duties
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(attach additional sheets if necessary)
14. List positions of leadership/membership that you have held or now hold (student and
community organizations)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
15. Awards and honors received
________________________________________________________________________
________________________________________________________________________
16. Attach a maximum of a two-page essay outlining your background, attitudes towards
conservation, objectives of your educational program, career plans and financial need.
17. References: Please attach two letters of recommendation to this application.
18. Attach most recent transcript with grades (copy)
I certify the above to be true and correct.
Signature of applicant ___________________ Date_______
Signature of college advisor _____________________ Date_______
Mail application with supporting materials attached
postmarked no later than November 19, 2015 to: Danny
Hughes, 78 Barnes Drive, Monticello, KY 42633