Wayne & Alma Kay Scholaship Application
Deadline for application is March 22nd
March 05, 2010
Please Click on the Button to the right of this article to download the application.
Wayne & Alma Kay Scholarship
Bucklin United Methodist Church
Scholarships are limited to students who are a high school senior or first three years in college with a 2.5 GPA; will complete a minimum of 12 credit hours in college with a 2.5 GPA.
Personal Information
Last Name:__________________ First Name:__________________
Address:___________________________________________
Date of Birth:_________________Phone Number:_________________
Cell Phone:__________________
Present Education Status:
__ High School Senior ___ 1st Year College ___ 2nd Year College ___3rd Year College
________________________________ _____________________ _________
High School or College Presently Attending City State School Year
________________________________ __________________ _________
College Planning to Attend City State School Year
List Additional Educational Courses or Colleges Attended
Name of School Graduation Date College Hours GPA
_________________ ________________ ____________ ______
__________________ ________________ ____________ ______
List participation in school activities:
______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
List participation in church and community services:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
List honors and awards received:____________________________________________
_______________________________________________________________________
_______________________________________________________________________
List prior employment: ____________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Family Information
Father’s or Guardian’s Name: ___________________________________
Address: ____________________________________________________
Occupation: _________________________________
Mother’s or Guardian’s Name; __________________________________
Address: ____________________________________________________
Occupation: _________________________________
Please list the names and ages of all siblings/children:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
How many are in college or other Post-Secondary education? ___________________
Where do you plan to live while in school? (please check one)
___Parents ___Relatives ___Self ___Spouse ___Roommate ___Dorm ___Other
Additional Requirements
- Attach a brief hand written essay explaining your goals and visions for your future.
- Attach an official High School or College Transcript for each school attended.
- You will be notified of a time for a personal interview with the selection committee.
- Your application must be returned by March 22
- BHS Principal PO Box 8, Bucklin, Kansas 67834
I certify that the foregoing statements and attachments are true and correct to the best of my knowledge.
_________________ ________________________________________________
Date Signature of Applicant
Committee members are: Jim Imel, Bucklin UMC Minister, Joan Immell,
BHS Principal/ Superintendent, Kim Ellis and Sue Kirk.
