DEADLINE: TO BE RETURNED BY APRIL 1
SCHOLARSHIP
APPLICATION FORM
Merlin & Ethyl Rufer Scholarship Trust
Part I:
Resume:
Name of Candidate:
__________________________________________________________________________
(Last) (First) (Middle)
Home Address:
______________________________________________________________________________
(Street) (City/Town) (Zip
Code)
Email address:
____________________________________________________________________________
Telephone No.:_____________________________ Social
Security No.: ________________________________
Name of High School:
________________________________________________________________________
Name of Iowa College/University Admitting Candidate:
_____________________________________________
Address:
___________________________________________________________________________________
(Street) (City/Town) (Zip
Code)
Phone number of Registrar of College/University
Admitting Candidate: __(_____)_____________________
Candidate's Intended Major Area of Study:
________________________________________________________
Candidate's Vocational Goals:
__________________________________________________________________
___________________________________________________________________________________________
Candidate's Academic Status: Cumulative
G.P.A. (3 years) _____________
A.C.T.
Percentile _____________
A.C.T.
Composite _____________
Part II:
Family Status:
Name of Father (if living):
________________________________________________________________
Name of Mother (if living):
_______________________________________________________________
Address (if different from Candidate's): _____________________________________________________
____________________________________________________________________________________
Occupation of Father: ___________________________________________________________
Occupation of Mother:
__________________________________________________________
Total Annual Income of Parents: ___________________________________________________
Number of children still being supported and living at
home: _________
Note: If
candidate is under the care of a guardian, please indicate
name, address and occupation of same by simply crossing
out "Father" and "Mother" and entering
"Guardian".
Part III:
Candidate's Estimated Sources of Financial Support for Initial Year of
College:
Social Security Benefits: $______________________________________________
Personal Savings: $______________________________________________
Parental Support: $______________________________________________
College Employment: $______________________________________________
Other (Specify): $______________________________________________
NDSL: $______________________________________________
SEOG: $______________________________________________
BEOG: $______________________________________________
Total: $______________________________________________
Part IV:
(For use by College/University student who has previously been awarded
the
Merlin & Ethyl Rufer Scholarship):
Name of College Currently Attending:
____________________________________________________
Year in College:
_____________________________________________________________________
Grade Point Average as of this Date:
_____________________________________________________
List any Additional Necessary Information:
________________________________________________
_________________________________________________________________________________
Part V:
Additional Data Including Extracurricular
Activities -- (Please attach):
NOTE: I understand that this application is not
complete unless there is:
1) A letter from my
Superintendent/Principal or Academic Advisor
2) A personal request and resume
both
in support of this application.
Date: __________________ Signature of Applicant:
_________________________________
Part VI:
Please drop off or mail this completed application to me no later than
April 1st.
Phone: (515)573-3452 Member
of
Email:
dand1@frontiernet.net
(it is a #1 after 'dand' above)