ILLINOIS
PAINT HORSE ASSOCIATION
SCHOLARSHIP
APPLICATION
PART 1 - GENERAL
INFORMATION:
Name: _______________________________________________________________________________
Home
Address: _______________________________________________________________________
Street town zip
Home Phone: _____________________________ Cell Phone: _______________________________
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 for or attending:
______________________________________________________________________________________
Expected
Graduation Date:
_____________________________________________________________
Have you received
an IPHA scholarship in the past? ____
No ____ Yes, year ________
What is your
planned major/minor or area of study?
Please be specific._______________________
______________________________________________________________________________________
______________________________________________________________________________________
Parents’ Names: ______________________________________________________________________
Parents’
Address: _____________________________________________________________________
PART 2 - ACADEMIC
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 3 - OTHER
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 4 - FINANCIAL
INFORMATION:
What is your
level of financial need? _____________________________________________________
PART 5 PERSONAL
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:
Jerry
Wyrick
12336
N 2850 East Rd.
Ellsworth,
IL 61737
309-826-7157
JWyrick300@ctechinternet.com
6-1-10