Graduating Seniors - Lewistown Schools

Central Montana Foundation and Area Clearinghouse Scholarships
Universal Application Central Montana High School Seniors
Due Date is March 16, 2015
This universal application is 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.
Applicant Name:
I am currently:
I am interested in becoming a(n):
A Graduating High School Senior
A High School Equivalency Student
(formerly GED) or recent HSE Graduate
High School(s) Attended:
Type of Post-Secondary Institution Attending or Planning to Attend:
Vo-Tech/Trade School/Jr. Coll. (2Yr)
Specialized School (Art, Music, etc.)
University or College (4Yr)
Post-Secondary Institution Planning to Attend:
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) - See website for specific information
A variety of scholarships are available for graduates from Fergus High, Fergus County, or Central Montana Area
Schools. Included are the FCHS Class of 1935 and the Dorothy Ileene Eklund scholarships.
Central Montana Foundation Community Service Scholarship (College, University or Vo-Tech)
For FHS graduating seniors. Applicants must be able to document 100 hours of service in last year (attachment required).
Hannah Bragg Educational Scholarship (College or University)
For a Fergus High graduating senior pursuing a degree in education.
Fergus Federal Credit Union (College, University or Vo-Tech)
For Central Montana graduating seniors. Applicant or parent must be a member.
Friendship Lodge #37 - Masonic Scholarship (College, University or Vo-Tech)
Four year scholarships for Fergus High, Roy, or Winifred graduating seniors (attachment required).
PIE and Nan Marty Memorial Scholarship (College, University or Vo-Tech)
For a graduating senior from Winnett High School.
Petroleum County Community Service Scholarship
For Winnett High School Juniors and Seniors. Applicants must be able to document 100 hours of service in the past year
(community service attachment required.)
Lewistown Art Center Scholarship (College, University or Vo-Tech)
For graduating seniors pursuing a Visual Arts or Performing Arts related degree (portfolio required - can be digital).
Lewistown Education Association Scholarship (College or University)
For Fergus High graduating seniors or graduates pursuing an educaiton degree at a Montana College or University.
Lewistown Kiwanis Club (College, University or Vo-Tech)
For graduating seniors in Central MT with community service and financial need.
Lewistown Rotary Club Scholarships (College or University)
For a Fergus High and a Central Montana graduating senior who plan on attending a College or University.
Montana Family Dentistry Scholarship (College or University)
For a graduating Senior from Central MT planning on pursuing a healthcare-related career (attachment required).
Jim Schultz Memorial Scholarship (College or University)
For Fergus High School vo-ag senior majoring in agricultural-related field (attachment required).
Dale Godfrey Memorial Scholarship (College, University or Vo-Tech.)
Central Montana graduating senior who have participated in vo-ag and FFA (attachment required).
This universal application form is to be used when applying for Central Montana Scholarships; regardless of the
organization; and 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. If you are an HSE student
use your high school and HSE experiences relating to each of these sections.
I.
Grade Information - High school seniors should use their seventh semester grade information when completing
this part of the application. HSE students should use their high school grade information.
Cumulative G.P.A.:
Class Rank:
Number in Class:
II. Specialized Course Information - Due to the specific nature of several scholarships, please list all vocational and/
or advanced placement courses you have completed and/or are presently completing; i.e. Keyboarding/
WordProcessing; Business Law; Agriculture Education II, etc.
III. Scholastic and/or Achievement - Potential examples include, but are not limited to Honor Roll, Student of the
Month, Kiwanis Awards, FFA or BPA Awards, Dean's List, etc.
IV. Leadership - Please list any offices held or leadership opportunities you have had or taken ownership in, and
identify year of involvement. For example: Band Council Representative - 11.
Name:
V. School Activities - Please list extra-curricular, athletic or club-related activities you participated in and identify
year of involvement. For example: Basketball - 11; Pep Band - 9, 10, 11, 12.
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: CMY Mentor - 1 hour per week for 7
months; Boys & Girls Club Volunteer - 2 hours per week; Tutor - 1 hr/week; etc.
Honors and Awards
(Not previously listed) - Potential examples include, but are not limited to: Boys or Girls State,
4H Congress, National Science Bowl Participant, Award; Scholarship Award; Worker of the Month, 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, with most recent first.
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 and feel free to use two pages if
necessary. Your signature is required.
- Discuss some issue of local, national or international concern and its importance to you.
Recommendations & Transcript
Please attach to this application a copy of your official school transcript. Make sure it includes all
of your current coursework. Include three letters of recommendation from non-family members.
One recommendation must come from a teacher or professor, but no more than two from school
staff.
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.
Date:
Signature of applicant:
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: