Butternut Common Scholarship
Applicants are asked to complete the following form in its entirety. After application is completed submit form. Turn in the following to your School Counselor:

1) a copy of your high school transcripts (from any schools attended aside from Butternut School District)

2) two letters of recommendation (details provided in the application below)

Applications are due no later then the end of the day on April 15th.

Special Note: Although it appears on the list, a particular scholarship may not be made available this year. It is important for the applicant to indicate which scholarships he or she is apply to.

Full Name of applicant:
(Your full legal name)
Your answer
Today's Date
MM
/
DD
/
YYYY
Date of Birth
MM
/
DD
/
YYYY
Mailing Address:
Your answer
Expected Graduation Date:
(from high school)
MM
/
DD
/
YYYY
Email:
(Currently used email)
Your answer
Have you applied for college?
(Check one that applies to you)
If yes, where:
(Name of institution to where you applied)
Your answer
Have you been accepted?
(Check one that applies to you)
If yes, list your intended program of study:
Your answer
Please indicate your college entry assessment scores for the following:
ACT, SAT, Accuplacer, Compass, Other
Your answer
List any sports, extra-curricular activities, groups, organizations, or offices held during your high school experience.
Please indicate which years you participated in each activity: Freshman Year, Sophomore Year, Junior Year, and/or Senior Year
Your answer
Explain the values, principles, or skills you learned and developed during your time within the above sports, extra-curricular activities, groups, organizations, or offices held during your high school experience.
Your answer
List any honors or awards earned during your high school career.
Your answer
List and explain your leadership roles during your high school career.
Your answer
List community activities.
(Examples: youth groups, church work, volunteer work, community service, etc.)
Your answer
Student Explanation
Describe your goals in the following categories: future education, personal life, career, and community/society service.
Your answer
Students must submit two letters of recommendation along with their completed application.
Possible people to consider to write a letter on your behalf are coaches, teachers, school counselor, principal, boss, supervisor, religious member, family friend or community member (family members are excluded, and will not be accepted). By checking the box below you understand that 2 letters of recommendation need to be included along with your application, and will provide them prior to application acceptance.
Required
Many scholarship committees require a transcript as part of their criteria to be eligible for their scholarships. Please check the box below to give permission to release your transcript.
Required
As the applicant, I wish for this application be shared with the following scholarship opportunities:
Your answer
I certify that all preceding information is complete and accurate to the best of my knowledge: (please type your full name)
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Butternut School District. Report Abuse - Terms of Service - Additional Terms