College Application

Central Montana Scholarships
Universal Application - Post Secondary Students
Due Date is April 15, 2015
This universal application is for prior year Central Montana graduates who are applying for the scholarships listed
below (several have multiple scholarships available). The application is in a fillable PDF and must be typed.
Handwritten applications will NOT be accepted, with the exception of the scholarship narrative which must be
handwritten by the applicant. Individual scholarships may use different parts of the application, so it is important to fill
out all sections. All answers must be limited to the spaces provided within the application. The only attachments to
the application are the recommendation letters, your official transcript and any additional page(s) needed for a specific
scholarship, as listed below. Check the box below for each scholarship you would like to be considered for. Also,
please complete and check the boxes that apply to your current status and plans.
I am currently
Applicant Name:
I am interested in becoming a(n):
Attending a Post-Secondary Institution
Planning to Attend a Post-Secondary Insitution
Name of Post-Secondary Institution Attending or Planning to Attend:
Type of Post-Secondary Institution Attending or Planning to Attend:
Vo-Tech/Trade School/Jr. Coll. (2Yr)
Name of high schools and years attended.
Type of High School Completion:
Specialized School (Art, Music, etc.)
High School GPA -
University or College (4Yr)
High School Class Rank -
High School Diploma - Year
HSE - Year
(Formerly GED)
Please check all the scholarships you would like to apply for
Brooks Community (College, University or Vo-Tech) - See guidelines for qualification.
For graduating seniors or graduates who have resided in the Brooks or Hilger area during high school.
Central Montana Foundation - (College, University or Vo-Tech)
A variety of scholarships are available for graduates from Fergus High, Fergus County, or Central
Montana Area Schools. Included is the FCHS Class of 1935 and the Dorothy Ileene Eklund scholarships.
Delta Kappa Gamma/Irene C. Miller (College or University)
For a Fergus, Petroleum, Wheatland or Judith Basin County high school graduate working towards an
education degree at an accredited post-secondary institution (attachment required).
Lewistown Education Association (College or University)
For a graduate pursuing an education degree at a Montana College or University.
Lewistown Kiwanis Club (College, University or Vo-Tech)
For a graduate with community service that shows financial need (attachment required).
Pat Descheemaeker Scholarship (College or University)
For a graduate of Fergus High School or Grass Range High School who is active in college track or cross country
Winnett Lions Club (College or University)
For a graduate of Winnett High School entering second year of college or above.
Winnett PIE (College or University)
For a graduate of Winnett High School entering second year of college.
Elisabeth Coolidge Nursing Scholarship (College or University)
For a Central MT graduate pursuing education towards a Nursing degree at MSU-Northern or Montana Tech
Maiden School Scholarship (College or University)
For a graduate from Fergus County attending a college or university with two-years FFA experience.
This universal application form is to be used when applying for Central Montana Scholarships; regardless of the
intended accredited college, university, or vocational/technical center each individual applicant applies to.
Applicants will be scored on all information provided, so make sure all of your information is complete. Several
of the scholarships require additional information or attachments. You are responsible for their inclusion.
Personal Information
Applicant Name:
Home Address:
City, State, Zip
Home Phone:
Gender:
Age:
Birthdate:
Parents' Name(s):
Parents' Occupation(s):
Educational Information
Please use applicable school information to complete this section of the application. The use of college level
information must be used on all sections. Do not include your high school grades or activities. (College freshmen
will only have the first term grade information.)
I. Grade Information - Students currently in a post-secondary institutions are to list their grade information for the
past three years of school. List each terms information separately, as well as their current cumulative G.P.A.
School Year:
Term -
G.P.A.-
; Term -
G.P.A.-
; Term -
G.P.A.-
School Year:
Term -
G.P.A.-
; Term -
G.P.A.-
; Term -
G.P.A.-
School Year:
Term -
G.P.A.-
; Term -
G.P.A.-
; Term -
G.P.A.-
School Year:
Term -
G.P.A.-
Current Cumulative G.P.A.:
II. Specialized Course Information - Due to the specific nature of may of the scholarships available please list the
courses you have taken, or are taking, within your major or minor. Include the grade you recieved (if completed).
III. Scholastic Achievement - Potential examples include, but are not limited to Honor Roll, Student of the Month,
Department or Major Area Awards and Scholarships, Dean's List, etc.
Name:
IV. Leadership - Please list any offices held or leadership opportunities you have had or taken ownership in, and
identify year of involvement. For example: Campus Student Senate - SO
V. School Activities - Please list extra-curricular, athletic or club-related activities you participated in and identify
year of involvement. For example: MSU Spurs & Fangs - SO; UM Ambassador - JR, etc.
Community Information
I.
Community Activities & Organizations - Please list all the non-school related activities you have
participated in and level of involvement. For example: Church or Recreational Activities; etc.
II. Volunteer Service - Please list all volunteer or community service activities you have participated in. Indicate the
level of involvement in terms of hours per week, month or year. For example: Big Brother - 1 hour per week for 7
months; Boys & Girls Club Volunteer - 2 hours per week; Tutor - 1 hr/week; etc.
Institutional Information
- Please indicate your first and second choice of post secondary schools, colleges or
universities you plan to attend. List the necessary information requested below.
Primary Choice
School Name:
Major or Program:
Tuition and Fees:
Room and Board:
Books (Estimated):
Secondary Choice
Name:
Work Experience
- Please list the job, or job related experiences, you have had. Complete each section below for
each individual employer. If you have more than four, please list the last four employers.
Employer #1:
Supervisor:
Nature of Work:
Start Date:
/
/
End Date:
/
/
Av. Hrs/Week:
Employer #2:
Supervisor:
Nature of Work:
Start Date:
/
/
End Date:
/
/
Av. Hrs/Week:
Employer #3:
Supervisor:
Nature of Work:
Start Date:
/
/
End Date:
/
/
Av. Hrs/Week:
Employer #4:
Supervisor:
Nature of Work:
Start Date:
/
/
End Date:
/
/
Av. Hrs/Week:
Employer #5:
Supervisor:
Nature of Work:
Start Date:
/
/
End Date:
/
/
Av. Hrs/Week:
Other Circumstances - Are there other circumstances that the selection committee should be aware of (list below)?
How many college students will be in your family for the upcoming year?
Name:
Scholarship Essay
In your own words, please use the attached essay form to complete a handwritten, essay (300
words or less) answering the following question. Use an ink pen to complete the essay and feel free
to use two pages if necessary. Your signature is required.
- Explain how your college experience will impact your future endeavors.
Recommendations & Transcript
Please attach to this application a copy of your current course schedule and a copy of your
official school transcript. Include three letters of recommendation. The letters must be from
non-family members with one recommendation from a teacher or professor.
Student Certification
I certify that the information given on this application is correct and that any further awards or other changes
will be reported to the Fergus High School guidance counselors.
Signature of applicant:
Date:
School Certification - This section is to be completed by your school's Superintendent, Principal, Counselor or
Academic Officer (as appropriate).
I certify that the above signed student:
a) is a full-time student;
b) is currently in good academic standing;
c) and who has maintained satisfactory academic progress in school.
Name of Institution:
Printed Name of Academic Officer:
Title:
Signature of Academic Officer:
Date:
A completed and signed paper version (electronic copies not accepted) of this application, and
necessary completed supplements, must be postmarked or submitted to the following address on or
before the due date as listed on the front page.
Guidance Department
Fergus High School
1001 Casino Creek Drive
Lewistown, Montana 59457
Scholarship Essay Form
Applicant’s Signature:
Date: