TIMOTHY SCOTT WIRTH MEMORIAL SCHOLARSHIP
For graduates of Linn County secondary schools entering, transferring, or continuing
undergraduate studies in the Oregon State University College of Agricultural Sciences.
Please type or print legibly in dark ink.
Attach copy of transcripts or copy of SAT scores if you are entering from high school.
Application Deadline: March 1 - Use this application form or go to the website:
http://cropandsoil.oregonstate.edu - for on-line scholarship application form.
Return applications to: Tracy Mitzel, Department of Crop and Soil Science, 109 Crop Science
Building, Oregon State University, Corvallis, OR 97331-3002. Questions: Call (541)737-5712.
Name (last, first, middle)
OSU ID or Social Security Number
Proposed dept. major at OSU
FR
SO
JR
SR
Year in college next fall
High School last attended
City
County State/Zip
(
)
Tel. number
Expected graduation date
Date graduated
SAT Scores:
Cumulative high school GPA
Cumulative college GPA
Math
Verbal
Last term college GPA
Total college hours:
as of next June
taken at OSU
Your mailing address during school year (including zip code)
transferred to OSU
Your email address
Your permanent address (including zip code)
Parent/guardian name(s)
Hometown newspaper
Statement of Financial Need
Percent self-support (portion of your expenses paid by you while at college): __________%
Additional comments on financial need (source of support, special circumstances, etc.):
Briefly state your professional goals and interests:
On another sheet, in 200 words or less, discuss an event you have experienced within the past five
years that has contributed significantly to your personal growth. (attach sheet)
Activities, honors, awards (include honoraries, offices held, committees, living groups, professional
societies, etc.). An additional sheet may be used if more space is needed.
A. High school/college:
B. Community activities:
C. Other:
Past work experience related to major and goals
Employer:
From:
To:
From:
To:
From:
To:
Duties:
Employer:
Duties:
Employer:
Duties:
Letters of Reference
Applicants are asked to solicit three letters of reference from the following persons:
1) a character reference, 2) a high school teacher or counselor, 3) an employer.
These letters may be included in the application or sent by the writer directly to:
Crop and Soil Science Department (use address listed on first page of this application).
I, the undersigned, certify that the above information is correct, and grant my permission to the
Department of Crop and Soil Science to release information from this application to scholarship
donor agencies and the media. (PLEASE NOTE: Your signature is required for a complete
application.)
Signature
Date