Shanna and Whitey Ellsworth Scholarship Application

Belding High School holds an important place in the hearts of Wendell and Shanna Ellsworth. They both graduated from Belding High in 1959.

They are generously sponsoring a $1,000 scholarship to go to a graduating senior who is continuing their education after graduation.

Mr. and Mrs. Ellsworth will make the selection of the recipient from the following application and essay.

Please make sure your high school is eligible for this scholarship.

Name

First Name

Last Name

Middle Initial

Phone

(###)

###

####

Email Address

General email address that will be used after High School

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

SCHOOL INFORMATION

Grade Point Average (GPA) - High School

Number of Students in Class

Rank in Class or Laude Points

List in chronological order all schools attended in the last four years, including any summer or special courses.

Include - Name of school / Location (city) / Dates of Attendance

List any academic distinction or honors you have earned and the grade levels in which you earned them (9, 10, 11, 12)

ACTIVITIES

Note those activities in which you have been actively engaged (organizations, sports, or clubs) and which you feel have been most meaningful to you (include years of participation, grade, levels, and any offices held)

WORK EXPERIENCE

List employment you have held in the past three or four years

Position / Employer / During the Summer or School Year / Dates / Number of Hours Per Week

HIGHER EDUCATION AND PUBLIC SERVICE

If applicable, the College or University you have been accepted to

What field of study?

Anticipated enrollment date

YYYY

Have you been awarded (or reasonably expect to receive) other grants or scholarships?

Yes

If yes, please list the name of the scholarship and the amount you will receive below

FAMILY INFORMATION

Parents: (Check if living)

Mother

Father

Stepmother

Stepfather

Legal guardian

Number of Children in Family

If you have siblings, number who will be in college

ESSAY

Write a statement of NO MORE THAN 500 WORDS discussing your goals, what you consider to be your strong points, and why this scholarship should be awarded to you.

REFERENCES

Letters of reference are not required. However, at least one reference and no more than two references of the applicant’s choice should be named. The selection committee reserves the right to contact these references. References cannot be family members or peers.

Include - Name / Phone #

DUE DATE

Please submit by March 31st unless stated differently guidance office

SIGNATURE

I certify that all the above information is true to the best of my knowledge.

Type name below

Today's Date

YYYY