PERSONAL INFORMATION

Name

Address

City State   Zip

Home Phone Email

Age    Are you currently employed? Yes No   

Employer   

Number of hours worked per week? Less than 10 10-20 20-30 Over 30   

Address of employer

Name of parents or guardian

Parents address if different

Occupations of each

List brothers and sisters in college and where:

EDUCATION

Year of high school graduation  GPA   

Class Rank   out of    ACT score

SAT score

Colleges attending (if any):

Name    Hours    GPA

Name    Hours    GPA

College which you plan to attend

Have you been accepted? Yes No Planned major

ACTIVITIES AND HONORS

Please confine all answers to the space provided.  Do not use attachments.

List, in order of importance to you, extracurricular and community activities which you have participated in:

List honors and awards (not scholarships) you have received:

If you have received, or will receive, scholarships indicate the name, agency granting it and amount:

FOR OUR INFORMATION

Have you had any experience in the agricultural industry? Yes No

If so, please explain:

Briefly explain why you should be considered for the Kansas Certified Crop Adviser Program scholarship. Include career goals. (do not use attachments)

How did you find out about this scholarship?

REFERENCES

*Please ask two people who know your abilities to write a support letter of this application. Give the information below of the two you have asked.

1. Name

Address

Occupation Phone

2. Name

Address

Occupation Phone

Please mail high school transcripts, college transcripts (if any), two reference letters and ACT/SAT scores to:

Kansas Certified Crop Adviser Program

Attn: Sarah Bowser

816 SW Tyler, Ste. 100

Topeka, KS 66612

If you have questions, please call Sarah Bowser at (785) 234-0463 or email at Sarah@KansasAg.org.