FRANK AND CLARA NIES SCHOLARSHIP

STUDENT SCHOLARSHIP APPLICATION

All items must be completed.  Please type your responses.  Feel free to attach additional sheets if your responses do not fit in the space provided.

1.  NAME ________________________________________

2.  ADDRESS ______________________________________________

3.  ACT (composite score) _______________________

4.  RANK IN CLASS _______ of ________

5.  GRADE POINT AVERAGE _____________

6.  PLEASE DESCRIBE YOUR WORK/JOB EXPERIENCE DURING THE LAST                                          FOUR YEARS.

7.  PLEASE LIST YOUR SCHOOL ACTIVITIES AND ANY OFFICES HELD IN ORGANIZATIONS.

8.  PLEASE LIST ANY SPECIAL HONORS OR AWARDS YOU HAVE RECEIVED.

9.  WHAT ARE YOUR AREAS OF SPECIAL INTEREST OR TALENTS?

10.  WHAT TYPE OF COMMUNITY SERVICE WORK HAVE YOU DONE?

All information is accurate and complete as provided.

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Student's Signature                       Date