FIRST COMMUNITY BANK SCHOLARSHIP

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					            JACKIE SIMMONS MEMORIAL SCHOLARSHIP

Student’s Name:
Address:
City:          State:          Zip code:
Social Security No.:
Father’s Occupation:
Mother’s Occupation:
Number of brothers and ages:
Number sisters and ages:
Number of immediate family members presently attending colleges:
Work experience:




ACT Composite:                 GPA:          Class rank:
College/Voc. Tech. School choice:
Extracurricular activities—Organizations and clubs (include offices held if appropriate:


Honors and Awards:




Community or other activities:




           1. The recipient shall plan to achieve a degree in education with aspirations
               of becoming a teacher.
           2. The recipient shall show financial need for post-secondary education
               costs.
           3. The recipient shall show qualities of scholarship and leadership.