b'Illinois Paint Horse Association Scholarship ProgramPart 1General Information:Name:______________________________________________________________________________________________________Home Address: ______________________________________________________________________________________________ StreetTownZipArea Code & Home Phone:_______________________________Area Code & Cell______________________________________High School Attended:________________________________________________________________________________________ City, State of High School Attended: _____________________________________________________________________________ Expected Graduation Date:_____________________________________________________________________________________Community College Attended:__________________________________________________________________________________ City, State of Community College:_______________________________________________________________________________ Expected Graduation Date:_____________________________________________________________________________________Junior College/College/University currently accepted by or attending:____________________________________________________________________________________________________________ Expected Graduation Date:_____________________________________________________________________________________Have you received an IPHA scholarship in the past? No___________ Yes,________________________________________________What is your planned major/minor or area of study? Please be specific . __________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________Parents Names: _____________________________________________________________________________________________ Parents Address:_____________________________________________________________________________________________Part 2Academic Information:What was your high school GPA?________________________________________________________________________________High School class ranking?_____________________________________________________________________________________What was your ACT score? _____________________________________________________________________________________What is your current overall GPA if enrolled at a two or four year school?________________________________________________Part 3Other Activities:List other clubs you have belonged to (i .e ., FFA, 4-H, Pony Club) as well as any other academic or community activities in which you have been involved . Indicate your level of participation, leadership positions held, etc .:________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________List awards received within the horse industry:_____________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________Part 4Financial Information:What is your level of financial need? _____________________________________________________________________________Part 5Personal References:Please submit two character-reference letters with this application . References may not be relatives of the applicant or members of the Scholarship Selection Committee .Return this application to: (Deadline is August 1st)Jerry Wyrick 12336 N . 2850 East Road Ellsworth, IL 61737 (309) 826-7157 JWyrick300@ctechinternet .com2019 DirectoryPage 25'