Whaley

							                               Application Information

       Chuck and Larry Whaley Memorial 4-H & FFA
                    Scholarship Fund
                                  Whaley Application
                                       Typed

To be eligible for this award, the applicant must meet the following criteria:

       To provide support to a graduating North Newton or South Newton senior who is
        a current 4-H &/or FFA Member.




For consideration, all applicants need to complete and return this Application to:

                    Newton County Community Foundation
                               P.O. Box 295
                            Rensselaer, IN 47978




                                 Application Due by:

                        Tuesday, March 13, 2012 by Noon




NOTE:          The Newton County Community Foundation is NOT responsible for
               misdirected Applications not received in our office.
             APPLICATION FOR THE
  CHUCK and LARRY WHALEY MEMORIAL 4-H & FFA
                 SCHOLARSHIP

DUE DATE:
March 13, 2012 by Noon to the Newton County Community Foundation

TO: Newton County Community Foundation

Please attach a photograph.

Name:__________________________________________________________________

Address:________________________________________________________________

Parent/Guardian Name:_____________________________________________________


Phone Number:___________________________________________________________


High School you are attending: North Newton______        South Newton______


Other Scholarships you already know you are receiving. Please list names and amounts.
(Please attach a separate sheet if necessary.)____________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Institution you have enrolled in to continue your education:________________________

________________________________________________________________________


Length of time the program will take to complete:________________________________


Degree or Certificate you plan to obtain:_______________________________________
Occupational Goal you have for yourself:______________________________________

________________________________________________________________________


Describe your involvement with the Newton County 4-H &/or FFA Program. Please
include years, projects, awards and what you have gained from your association with the
program. (Please attach a separate sheet if necessary.)




What is one of the most interesting experiences you have had as a 4-H &/or FFA
member? (Please attach a separate sheet if necessary.)




_______________________________________________              ______________________
Signature                                                     Date