Montana Clerk and Records Scholarship 2019
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APPLICANT INFORMATION
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Mr.
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Ms.
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(Last)(First)
(Middle Initial)
Telephone Number
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Permanent Address(street)(city)
(state)
(zip)
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Father's Full Name
Occupation
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Permanent mailing address of parent/
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guardian if different from applicant
(street) (city) (state) (zip)
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Mother's Full Name
Occupation
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Permanent mailing address of parent/
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guardian if different from applicant
(street) (city) (state) (zip)
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Total number of family members who will be attending a post-secondary
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school at least 1/2 time during the 2007-2008 school year, including applicant.
during the upcoming school year, including applicant.
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SCHOOL INFORMATION
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High School Attended
Graduation Date
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(Month)(Year)
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Address
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(street)(city)(state)(zip)
Telephone Number
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Name of post-secondary school for which applicant's scholarship is requested
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4 yr College/Univ
Vo-Tech
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Community College
Other
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Address
Accredited? Yes
No
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(city)(state)(zip)
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Major field of study applicant plans to pursue
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Applicant's Signature
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Date Completed
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Mo.DayYear
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STATEMENT BY PARENTS OR GUARDIAN:
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I have read this application, attest to the accuracy thereof to the best of my knowledge, understand that the
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candidate is applying for a Montana Clerk & Recorder's scholarship, and have no objection thereto.
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Parent or Legal Guardian's Signature
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Date Completed
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Mo.DayYear
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TRANSCRIPT INFORMATION
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High school seniors must include a high school transcript of grades and have the
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following section completed by the appropriate school official.
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Class/Rank:
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in a class of
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Cumulative grade point average
\4.0 scale.
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School Official's Signature
DateTitle
Telephone #
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PERSONAL INFORMATION
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Please list your work experience during the past 4 years. Indicate dates of employment in
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each job and the approximate number of hours worked each week. List total amount earned for
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each job.
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POSITION
Date From(mo/yr)
Date to (mo/yr)Hours Per WeekAmount Earned This Position
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EXTRA-CURRICULAR ACTIVITIES
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ACTIVITYNo. of Years Partic.Offices Held, Special Awards, HonorsACTIVITYNo. of Years Partic.Offices Held, Special Awards, Honors
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Make a statement of your plans as they relate to your educational and career objectives and future goals. (If necessary, attach additional pages.)
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