MUSKEGO AREA CHAMBER OF COMMERCE
P. O. BOX 234
MUSKEGO, WI 53150
STUDENT VOLUNTEER SCHOLARSHIP
APPLICATION FORM – 2011
($1000 scholarship)
DEADLINE TO APPLY: MONDAY, Jan. 2, 2012 (Senior Status Students Only)
RETURN TO: Muskego Area Chamber of Commerce
PO Box 234
Muskego, WI 53150
Please fill out the following information. Attach a copy of your transcript.
If you need additional room, you may attach additional sheets of paper.
NAME: _________________________________________________________________________
DATE OF BIRTH:_________________________________________________________________
HOME ADDRESS:________________________________________________________________
HOME PHONE: ___________________________________________________________________
FATHER’S NAME: ________________________________________________________________
MOTHER’S NAME: ________________________________________________________________
HIGH SCHOOL: ___________________________________________________________________
GPA: ____________ CLASS RANK: ________________________
DATE OF GRADUATION: _______________________________________________
ARE YOU APPLYING FOR A TECHNICAL SCHOOL?
ARE YOU APPLYING FOR A 4-YEAR COLLEGE?
WHAT SCHOOLS HAVE YOU APPLIED TO OR ARE UNDER CONSIDERATION?
BRIEFLY, EXPLAIN WHY.
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IF ALREADY ACCEPTED, WHICH SCHOOL ARE YOU PLANNING ON ATTENDING?
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STUDENT STATEMENT
Please attach a written essay of 150 words minimum expressing your educational objectives, your choice of career, and plans for reaching your goal. This portion of the application will be rated on content and writing skills.
STUDENT AND COMMUNITY ACTIVITIES
List community activities (outside of school) that you have been involved in or given time to. Please include honors received, office held, and services. If required, please use additional paper.
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List extra-curricular activities (sports, clubs, committees, etc.) you have participated in during your high school years. If required, please use additional paper.
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I hereby authorize my high school to release to the Muskego Area Chamber of Commerce a transcript of my high school records. I also certify that all information provided on this application and in support are true and correct.
Student Signature: _____________________________________________________
Date: _____________________________________________________
(Parent Signature required if student is under 18 years of age)
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FAILURE TO COMPLETE ALL SECTIONS AND SIGN APPLICATION
WILL DISQUALIFY APPLICANT.