1.       2.  

3.  

4.  

5. Parent's Name:  

6. Parent's Address:  

7. Grade Point Average(cumlative at end of last full semester):  

8. High school
    academic honors:
  


9. High school
    activities:
     Sports:  
  


     Clubs:  
  
     Community
     Service:  
  

10. College you plan to attend:  

11. Planned major:  

    

13. If so, how many hours per day?    

    

15. If so, how many hours per day?    

    

17. Please provide a narrative regarding:

    A. Why you believe you should be selected for a scholarship.
    B. Why you chose the field of study identified in question 11.
    C. Your future goals.



Signed:            __________________________________________

Date:            __________________________________________



This form must be typed, filled out completely and signed for you to be considered for a scholarship.

Application Deadline February 9th, 2018. This application shall be mailed to:
                Nickerson Alumni Association
                P.O. Box 463
                Nickerson, KS 67561

You will not be considered for a scholarship if your application is "received" after February 9th, 2018 !
The Alumni Association must have it in hand by that date, not just mailed by that date.



If selected to receive a scholarship by the Alumni Association you must attend the Alumni Awards Banquet, Jume 2nd, 2018,
in order to have your selected college receive the funds allocated in your name. Failure to attend for any reason other than an emergency
will result in cancellation of the scholarship.




DO NOT WRITE BELOW THIS LINE


For Alumni Association Use:

Received by:_______________________________________________Date_____________________________


Fall Semester 2018 Spring Semester 2019
Amount: Amount:
Fund Fund
Amount Amount
Fund Fund