Equity Cooperative


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	2010 College Scholarship Application

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 through

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)

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