LOCAL 1

BUTTE COUNTY EMPLOYEES ASSOCIATION

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1. Name ______________________________________________________________________

(First) (Middle) (Last)

Mailing Address ______________________________________________________________

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Phone ____________________Birth Date _______________________ Sex M ( ) F ( )

Name of Parents/Guardian ______________________________________________________

(Circle One)

Address ____________________________________________________________________

Father’s/Guardian’s Occupation _________________________________________________

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Mother’s/Guardian’s Occupation ________________________________________________

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2. List your first choice college major _______________________________________________

List your second choice college major _____________________________________________

List your career choice(s) as related to this major ____________________________________

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3. List your first choice college/university or vocational school:

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List your second choice college/university or vocational school:

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4. Transcript information:

Please attach a copy of transcript.

Cumulative GPA _______________

5. List any scholarships or awards you have received this year:

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6. Activities-List areas you have been involved in-give clear answers.

Class and Student body Offices __________________________________________________

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Athletics ____________________________________________________________________

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Music ______________________________________________________________________

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Drama _____________________________________________________________________

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Agriculture __________________________________________________________________

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Employment/Volunteer Work ___________________________________________________

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Journalism __________________________________________________________________

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Church _____________________________________________________________________

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Youth or community organizations (YMCA, YWCA, C.A.P. etc.)

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Any other organizations ________________________________________________________

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Hobbies ____________________________________________________________________

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Would any of the above activities tie in with your college goals? Explain.

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7. Are there any special situations or considerations that should be mentioned?

(Health, family situation etc.)

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Signature _______________________________

Date _______________________________

PLEASE SEE #8 “ESSAY” NEXT PAGE

8. ESSAY (Maximum, 500 words)

“I wish to be considered for this scholarship because.....” _____________________________

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