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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  ___ 1^st Year College   ___ 2^nd Year College   ___3^rd 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 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

1. Attach a brief hand written essay explaining your goals and visions for your future.
2. Attach an official High School or College Transcript for each school attended.
3. You will be notified of a time for a personal interview with the selection committee.
4. Your application must be returned by March 22
5.  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.