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WIMECA SCHOLARSHIP APPLICATION
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1. NAME:
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2. SSN (Last Four Digits):
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3. ADDRESS:
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4. MEMBER OF WHAT WIMECA UTILITY:
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5. HOME PHONE NUMBER:
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6. PARENT'S NAMES:
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7. CURRENT HIGH SCHOOL ATTENDING:
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ADDRESS:
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8. NAME OF COLLEGE PLANNING ON ATTENDING IN THE FALL:
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ADDRESS:
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9. COURSE OF STUDY INTERESTED IN:
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10. ARE YOU A U. S. CITIZEN?
YESNO
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STUDENT SIGNATURE:
DATE:
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PARENT SIGNATURE:
DATE:
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