NAME_______________________________________________________________________________
LOCAL ADDRESS______________________________________________________________________
_____________________________________________________________________
PHONE NUMBER____________________________ EMAIL ADDRESS_________________________________
HOMETOWN________________________________ COUNTY________________________________________
WYOMING RESIDENT? YES_______ NO____________
NAME OF HIGH SCHOOL FROM WHICH YOU GRADUATED_______________________________________
CITY/STATE OF HIGH SCHOOL_________________________________________________________________
W#__________________________________ GPA____________________________________________________
MAJOR_____________________________________ MINOR__________________________________________
AREA OF EMPHASIS__________________________________________________________________________
CLASS STANDING: FRESHMAN______ SOPHOMORE_____ JUNIOR_____ SENIOR______
ANTICIPATED GRADUATION DATE ___________________________
NON-TRADITIONAL STUDENT (25 years old or older): YES_____ NO______
SEMESTERS YOU WOULD LIKE TO USE THE SCHOLARSHIP FOR:
ACADEMIC YEAR ________ AND/OR SUMMER_______ (Summer aid is for COJO courses only)
If you apply for summer aid, how many summer courses would you like to take? _______
RESIDENT_______ NON-RESIDENT_______
IN NO MORE THAN 250 WORDS PLEASE TYPE AND ATTACH A BRIEF STATEMENT ADDRESSING HOW YOUR CAREER GOALS, GRADES, FINANCIAL NEED, EXTRACURRICULAR ACTIVITIES, INTERNSHIPS AND/OR EXPERIENCE SUPPORT YOUR APPLICATION.
NOTE: PLEASE PLAN TO ATTEND THE ANNUAL AWARD RECEPTION HELD IN APRIL HONORING THE RECIPIENTS.
