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Name _______________________________________________________________________________                       Phone ______________________________________
(Print)           Last                         First                     M

Date of Birth: __________________________________________________________________                    Soc. Sec. No. __________-_________-_______________
                  Month                    Day                     Year                                                      (Required)

Home Address: __________________________________________________ City: __________________________ State:                            WI       Zip:    532 ________
Parent/Guardian Name: ___________________________________________________________________________________________________________

Your School: _____________________________________________________________ Your Counselor: _______________________________________

I.    On a separate sheet list all present and past activities and/or service detailing your involvement in the community
      and in your school.

II.   On a separate sheet, briefly list your life goals and objectives.

III. Along with this completed application, please write an original essay of 500 words on one of the following themes:

          a. Because of the economic downturn in our country, employment for millions has been adversely impacted; even college graduates find
             it difficult to find a job. Discuss why you should stay the course in pursuing higher education.

          b. The recent earthquake in Haiti seemed to galvanize many people the world over. Why is this true after such a disaster and not before?


          1. The Willie D. Davis Scholarship Fund, Inc. will award scholarships in equal amounts to high school seniors who
             demonstrate a high level of academic achievement and participate in extra curricular activities. The 2010 recipients
             will receive $2,000.00 each.

          2. To be eligible, an applicant must be a senior in one of the greater Milwaukee area high schools; have a minimum 2.5
             (cumulative) grade point average; have good moral character and have shown respect for family and community.
             (This data must be confirmed by the school guidance counselor).

Counselor’s Signature: ________________________________________________________________                        Date: ___________________________

          3.   To enter, a student must submit in ONE COMPLETE PACKET :
                    Completed and signed application form
                    Copy of transcript for complete high school term to date
                    Photo (WALLET SIZE)
                    500 word essay on aforementioned subject
                    Two letters of recommendation from persons who can attest to the student’s character.
                            ***********MISSING ITEMS WILL CAUSE DISQUALIFICATION**********

IV.   All entries must be postmarked no later than midnight March 26, 2010 and mailed to the: Willie D. Davis Scholarship Fund,
      Inc., 4222 W. Capitol Drive, Milwaukee, WI 53216. All entries become property of the Willie D. Davis Scholarship Fund, Inc.

V.    Scholarship winners will be notified by 5 pm April 15, 2010.

VI.   All Scholarship recipients will receive stipends after proof of enrollment in an institution of higher learning.

VII. Employees and immediate family members of the Willie D. Davis Scholarship Fund, Inc., Milwaukee Radio Alliance and
     participating sponsors are ineligible.

VIII. The Willie D. Davis Scholarship is a one time non-transferable stipend which must be utilized within one year of the award
      date or be forfeited.

IX.    The decision of the judges is final.

X.     Scholarship recipients must be present at the Awards Ceremony, April 23, 2010


I, _______________________________________ have read and understand the rules for the Willie D. Davis Scholarship Fund, Inc.

Parent’s Signature ___________________________________________________________________                       Date: ___________________________

Student’s Signature _________________________________________________________________                        Date: ___________________________

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