Equity Cooperative


	Scholarship Form

Eligibility		Any student who has not received an Equity Cooperative Livestock Sales Association scholarship in the past is eligible to apply. Students needs to have completed two or more semesters at an accredited college or university, and any student who has completed at least one semester at a technical college. The student must have a cumulative grade point average of 3.0 or above, on a 4.0 scale. Either the student or their parent(s) must be an active shipping member of Equity. Please include an official transcript of your college, university or technical school and a copy of your spring course schedule. Three letters of reference are also needed, with at least one completed by someone outside of the educational field. Application, three letters of reference, and transcript need to be sumbitted by November 26, 2012. They can be sent separately or all together, however the applicant chooses.

Name

Age

Permanent Address

City

State

Zip

Email Address

Telephone Number

Name of parent(s) or guardian

Name of high school

Year of HS graduation

Rank in class (i.e. 10/270)

College, University or Technical School

Major

Equity location you or your parents market livestock

Please indicate number of head or number of acres in the following 12 categories:

Dairy cows

Dairy heifers & calves (if not applicable, leave blank)

Beef Cattle (if not applicable, leave blank)

Hogs (if not applicable, leave blank)

Sheep (if not applicable, leave blank)

Other (please specify)

Crops (total acres)

Corn

Soybeans

Alfalfa

Oats

Other (specify)

Leadership Positions held in all organizations (church, school, 4-H, FFA, etc.)

Awards & Honors Received (Fairs, Shows, etc.)

Describe your farm and future opportunities within your chosen field

A summary of significant events in your life, describing educational goals and future career plans

Have you received or do you intend to apply for other scholarships?

Choose Yes or No		Yes No

If yes, which scholarship(s) have you received or are you applying for?

Are you receiving any other financial aid?

Choose Yes or No		Yes No

If yes, what?

To verify cooperative member status, please include the patron name and number you or your parents market under (first six digits in upper right-hand corner of check stub as well as two digits directly below)

Farm Name

I hereby certify that the information contained within this application is true and to the best of my knowledge.

Check Box if you agree

Date of application

Campus Phone

Campus Address

Please type the text in the box.