JACKIE SIMMONS MEMORIAL SCHOLARSHIP
City: State: Zip code:
Social Security No.:
Number of brothers and ages:
Number sisters and ages:
Number of immediate family members presently attending colleges:
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
3. The recipient shall show qualities of scholarship and leadership.