PACD Auxiliary Scholarship Application

DEADLINE: This application must be completed and submitted to: Scholarship, York County Conservation District, 118 Pleasant Acres Road, York PA 17402 by June 15.

APPLICANT:

Name: _______________________ Soc. Security #:_____________

Home Address: __________________________________________

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City: ____________________ State:_______ Zip:_______________

Telephone #: ________________________________

PA College or University: ___________________________________

Major Course of Study: ____________________________________

Junior        Senior

Grade Point Average: _____________________________________

FINANCIAL STATUS:

I plan to meet education expenses by the following percentages:

FAMILY INFORMATION:

Mother ________________________ Occupation ______________

Father ________________________ Occupation _______________

Spouse ________________________ Occupation ______________

INSTRUCTIONS:

On a separate sheet of paper, please provide any information which might assist the Committee in the evaluation of your application, such as career goals, family responsibilities, education history since high school, your course of study and/or other facts applicable to the criteria.

Amount of scholarship will be $500 and will be paid to the recipient at the Annual Meeting of the PACD in July of each year.

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              Date                                              Signature