Northeastern Wisconsin Youth Scholarship

Educational Scholarship Application

All applications must be postmarked on or before November 1.

Please read the following information carefully and submit all necessary requirements.

This year NEWApHC will award a $100 scholarship.  The applicant must be a member of NEWApHC and in good standing.  Each applicant must submit a copy of the current fall semester registration from the college the applicant is attending. An official high school transcript is also required. Each applicant is reviewed by the current youth director who will then make a recommendation the the NEWApHC board.  The NEWApHC board of directors has the final decision of the scholarship winner. The check will be payable only to the institution the recipient is attending.

Additional Information:

1.The application must be made on an official form and must be filled out and signed by the person applying for the scholarship.  Forms can be found in newsletters, the directory, or the web site, or by contacting the youth director.

2. An official grade transcript form the applicant’s most recent high school must accompany the application.

3. This application must be received by the NEWApHC Director by November 1^st.

4. The scholarship will be presented to the recipient at the annual year end awards banquet.

5. Please return the application to:

Stephanie Rortvedt
N2736 Hickory Grove Rd.
Cascade, WI  53011

General Information

Applicant Name:______________________________________________________

Age:___________ Birthdate:____________ Telephone #:_____________________

Permanent Address:____________________________________________________

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Father’s Name:_______________________________________________________

Address:______________________________________________________

_______________________________________________________

Mother’s Name:______________________________________________________

Address:______________________________________________________

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Name of High School:__________________________________________________

Address:______________________________________________________

_______________________________________________________

Graduation Date (Month & Year):___________________________________

Name of College or Secondary Education Institution:___________________________

Address:______________________________________________________

_______________________________________________________

Date Enrolled:__________________________________________________

Major Area of Study:_____________________________________________

Areas of Interest/Extracurricular Activities

High School Activities Involved In (List Activity & Number of Years Involved):

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

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Hobbies/Interests/Activities Outside of School Involved In (List Activity & Number of Years Involved):

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

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Extracurricular Equine Activities

List the name and type of equine activities you have been involved in. List club, activity, and years. i.e.. NEWApHC, Youth Team Member, Happy Workers 4-H Club, Horse & Pony Project, 1998-2000.

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

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Scholastic Aptitude

Attach a copy of official grade transcripts from most recent high school or college.

List scholastic achievements/awards/activities. Indicate high school or college. i.e.. High School Honor Roll, Freshman & Junior Year.

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

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Applicant Essay

Summarize in the form of a letter and attach to the application your thoughts on the following (1) How has horses influenced your life, (2) Why do you desire to continue your education, and (3) What are your goals for the future.

Personal References

List two personal references other than relatives that could describe you as an individual if contacted by the Youth Director.
Name Relationship Phone Number

1._________________________________________________________________

2._________________________________________________________________

Applicant Signature

I hereby acknowledge the information contained in this application to be true to the best of my knowledge. I understand fraudulent information many result in disqualification.

________________________________________________ __________________
Applicant Signature Date