Len Assante Scholarship Information Sheet

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Len Assante Scholarship Information Sheet General Information: The National Ground Water Research and Educational Foundation dispenses the funds for awarding scholarships to advance young people in groundwater-related fields. Each year the amount may vary. The NGWREF Scholarship Task Force decides how to distribute the funds and the number of scholarships they would like to award after reviewing the pool of scholarship applicants for that particular year. Eligibility: Scholarships are granted for full-time undergraduate students only. Previous scholarship recipients are ineligible. The applicant must be entering a field of study that serves, supports, or promotes the groundwater industry. The scholarship is available to high school graduates and students in college (four-year program or well drilling two-year associate degree program). A 2.5 GPA is mandatory for high school or college students. Procedure: The application must be completed and received between October 15 and January 15 at NGWREF along with a complete transcript of grades. Applications will not be considered if official transcripts are not attached. Review: The NGWREF Scholarship Task Force will review the completed applications. Applications are evaluated on the information provided. Incomplete applications will not be evaluated. Awards: Based upon the funds available, the number and size of each award will vary. The NGWREF Scholarship Task Force may make the following awards: Past President s Award: Given to the most qualified applicant who has demonstrated high academic achievement. Groundwater Industry Award: Given to students enrolled in the study of groundwater, geology, or water well technology. Applicants from drilling schools with two-year associate degree programs are also eligible for consideration for this award. Ora Lyons Awards: No additional criteria are required for these awards. Applicant must meet the same standards as other scholarships established for the program. How did you hear about the National Ground Water Research and Educational Foundation Scholarship Program? q National Ground Water Association q Water Well Journal q State association newsletter q Other industry publication q Family member q Friend q Other

Len Assante Scholarship Application Application window: October 15-January 15 Name in full (print) Last First Middle Home address City State/Province Code Home phone with area code Country E-mail address q Male q Female q Single q Married q Other q Number of children Age Birth date High School Date of graduation Are you, or a relative, currently employed in the groundwater industry? q Yes q No If so, by whom? Company name Relationship to this person Address City State/Province Code Company phone with area code Country Are you a citizen of the United States? q Yes q No If no, type of visa? Name of college Address Is this a 4-year or a 2-year program? q 4-year q 2-year Date of proposed entrance to college Planned dates of attendance Proposed field of study: q Environmental Sciences q Geology q Hydrogeology q Hydrology q Microbiology q Well Drilling two-year associate degree program

NOTE: Include latest transcripts. If you are in college and were in high school less than five years ago, please include high school transcript as well as college transcript. Fill out activity portion on form as required. Do NOT substitute with personal attached sheets. Use additional sheets only if space provided is inadequate. Indicate which statement best describes your senior class, school, and student body. 1. Graduating Class Size q Small: 1-99 seniors q Medium: 100-199 seniors q Large: 200-349 seniors q Very Large: 350+ seniors; indicate number 2. A. Enter your exact rank in class at the end of your sixth semester (end of junior year) (a rank of 3 would be entered 003) B. Type of community (check one) q Rural q Urban q Suburban 3. GPA on a scale of (most recent academic environment) Please check below the activities, clubs, and/or sports you are involved in for BOTH high school and college if you are already in college. 4. CLUB 5. CLUB 6. CLUB 7. CLUB

8. ADDITIONAL CLUBS 9. SPORT Captain/Cocaptain (full season) Varsity letter 10. SPORT Captain/Cocaptain (full season) Varsity letter 11. ADDITIONAL SPORTS 12. ACTIVITIES - plays, musicals, art shows, etc. 13. SPECIAL RECOGNITION, AWARDS, HONORS, SCHOLARSHIPS, AND COMMUNITY INVOLVEMENT List special recognition, awards, honors, scholarships, and community involvement at the national, state, city, county, or school level. Include involvement in Girl Scouts or Boy Scouts and highest rank achieved. Special recognition Awards, honors, and scholarships Community involvement (include total hours per activity)

14. WORK EXPERIENCE INCLUDING PRESENT EMPLOYMENT List month/year of employment began and ended. Job description, hours per week, wages per week. PERSONAL STATEMENT: 1. Describe in 100 words or less the nature of your educational pursuit and the ambitions you have career-wise. 2. Use this space below to give the task force information about your background financial needs. (100 words or less). q I affirm the information that I have provided on this application, or any supportive financial aid materials, is complete, accurate, and true to the best of my knowledge. I understand that furnishing false information may result in ineligibility for the award. Applicant s signature Today s date Please return all five completed pages of the application, along with your transcripts, to: Scholarship Coordinator NGWREF Len Assante Scholarship 601 Dempsey Road Westerville, OH 43081