BILL HERR MEMORIAL
SCHOLARSHIP APPLICATION
NAME
ADDRESS
CITY & STATE & ZIP
BIRTHDATE
FATHER’S NAME
OCCUPATION
MOTHER’S NAME
PHONE No.
WHAT WILL YOUR COURSE OF STUDY BE
DO YOU WORK DURING THE SCHOOL YEAR
HAVE YOU HELD, OR DO YOU HOLD, A SUMMER JOB
WHAT PORTION OF YOU POST HIGH SCHOOL PLANS WILL BE FURNISHED BY YOU PERSONALLY
LIST THE SCHOOL AND COMMUNITY ACTIVITIES YOU ARE INVOLVED IN
(You may use a separate page)
How will receiving this scholarship help you achieve your educational goals, and why should the Third District Officials Association select you to receive this scholarship.
I hereby acknowledge that all statements are true to the best of my knowledge and beliefs. I authorize the Third District Officials Association to investigate all sources of the listed information provided by me.