STONE COUNTY SCHOLARSHIP APPLICATION The future is the minds of our youth. Strong minds build strong communities.

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STONE COUNTY SCHOLARSHIP APPLICATION The future is the minds of our youth. Strong minds build strong communities. Deadline for application is April 13, 2012. Return completed application to your counselor. ELIGIBILITY CRITERIA Applicant must be a graduate of Mountain View, Rural Special, or Timbo High School. High school graduates must have at least a 2.0 cumulative GPA and an ACT composite score of 17 or above (or a comparable score on the SAT, ASSET, or COMPASS) for students entering non-technical programs. College students must have at least a 2.5 GPA for the previous semester (first time and repeat applicants). Scholarship recipients must be enrolled as full time college students (12 hours minimum fall/spring semester or 6 hours summer).

STONE COUNTY SCHOLARSHIP APPLICATION The future is the minds of our youth. Strong minds build strong communities. Schools included: Mountain View Rural Special Timbo PERSONAL INFORMATION P.O. Box 356 Mountain View, AR 72560 Name (First) (Middle) (Last) Social Security No. - - Mailing Address City, State, Zip Telephone List savings you may have for educational purposes. Outline your summer plans and give the approximate amount you expect to earn this summer.

Give names and addresses of three persons who are not related to you that may be used for references. One must be a teacher or counselor. Name Address Attach a personal letter of approximately 200 words in which you discuss your ambitions and future plans. (May be typed or hand-written.) COLLEGE PREFERENCES List those colleges you are interested in attending in order of your preference. First choice Second choice Third choice Fourth choice Fifth choice Field of study in which you plan to major List estimated expenditures for your freshman year: Tuition: Room & Board Books & Supplies Commuting Expenses What activities do you plan to participate in during college? LEADERSHIP ABILITY Work Experience: List the jobs you have had since entering high school. Employer Dates of Employment Hours per week Duties

Activities: List your high school and community activities (other than jobs) in the order of interest to you. (Continue on a separate sheet, if needed.) Activity Number of years Honors: List any special honors and awards you have won or earned either in or out of high school. Honor or award Date awarded Please list any scholarships or awards received and amount. PLEASE READ AND SIGN THE FOLLOWING: Many of the scholarships require criteria or conditions to be met by the recipient. Changing your major or college may result in the termination of your scholarship. If you are awarded a scholarship, contact the high school office before making any changes. I certify that, to the best of my knowledge, the information given is accurate and complete. I understand that these scholarships are to be used the first two semesters of college and that I am expected to remain in school for at least that long. SHOULD I DECIDE TO DROP OUT OF SCHOOL WITHOUT COMPLETING A SEMESTER, I WILL BE WILLING TO REPAY ANY SCHOLARSHIP MONEY USED IN THE INCOMPLETE SEMESTER. This information will be made available to the scholarship donors. Signature Date THE COUNSELOR WILL SUPPLY THE FOLLOWING ITEMS: A copy of your high school transcript ACT Composite Score Grade Point Average Class Rank

STATEMENT OF PARENT OR GUARDIAN: This form must be executed by one of the parents, or by the guardian of the person applying for a scholarship from the Stone County Scholarship Foundation. This information will be made available to the scholarship donors. Name of parents or guardian Address Occupation of father Employer Occupation of mother Employer Please list the dependent children. Name Age School List any information which you would like to volunteer regarding your financial situation, or family circumstances that would be helpful to the scholarship donors in considering your child for a scholarship. Parent Signature Date