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2023
MD FFA SCHOLARSHIP APPLICATION
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Wiley G. & Carrie A. Griffith Scholarship
Application Deadline:
May 1,
2023
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UMCP College of Ag Past State Officer Matching Scholarship*
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(* Only page 1 is required for PSO enrolling at UMCP)
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I.
APPLICANT INFORMATION
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(First Name)(Middle Name)
(Last Name)
(Phone Number)(Social Security Number)
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(Home - Street Address and/or PO Box)(Home - City)(Home - State)(Home - Zip Code)
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(County of Residence)(US Citizen(Gender)(E-mail address)
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(FFA Member?)(FFA Chapter Name)(High School Name)
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(High School - Street Address &/or PO Box)(High School City)(H.S. State)(H.S. Zip Code)(H.S. Phone Number)
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II.
STUDENT CERTIFICATION & GOALS (Please respond to all questions.)
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1.In the fall2023 I will be a:
Full-time Student.
Part-time Student.
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2.
I plan to be enrolled in a:
Two year Program
Four year Program
A Continuing Education Program
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3.
I plan to attend school at:
Admission Confirmed? Y/N
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 (please include the official name of a post-secondary institution) (Attach copy of Acceptance Letter)
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4.
School Scholarship Office address:
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Phone:
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5.
My major field of study will be:
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6.
My career goal is to:
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7.
At the time of application I am a:
H.S. Senior
year college undergrad
Other as noted below
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8.
Are you a Maryland resident?
(1st, 2nd, 3rd, etc)
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III.
ACADEMIC INFORMATION - High School or College
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(If you have attended college, forward a copy of your most recent transcript. Class rank is not required.)
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The applicant's: Class RANK is
in a senior class of
students.
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Cumulative GPA is
on a 4.0 scale.
SAT Score:
or ACT Score:
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IV.
REQUIRED SIGNATURES
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1.
I hereby certify that the information submitted on this application is true and correct to the best of my knowledge.
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Applicants Signature:
Date:
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2.
I hereby certify that the academic information submitted on this application by the applicant is true and correct
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to the best of my knowledge.
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School Principal/Counselor Signature:
Date:
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(NOTE: An official school transcript of the applicant's academic record may be used in place of signature.)
Transcript Attached
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Send completed application to:
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Terrie Shank, Md FFA Exec. Director, MAFC, 925 N. East Street, Frederick, MD 21701
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Scholarship awards will be sent to the educational institution for deposit into the recipient's account.
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Each scholarship is awarded for one academic year and is not renewable. Previous recipients not eligible.
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(Page 1 of 3)
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2023Application for:
(Page 2 of 3)
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(Full Name)
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V.
FINANCIAL ANALYSIS DATA
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Please use income information from the most recent tax forms filed with the IRS.
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1.
Estimated educational expenses
$
per year.
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2.
I am a dependent
I am independent
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(If dependent, go to question 3, If independent go to question 5.)
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3.
Number of family members including myself.
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4.
Number of family members attending college including myself.
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Applicant/Student
Parent/Guardian
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5.
Personal income from non-farm employment
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as stated on most-recent tax forms
$$
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6.
Net farm income or (loss)
$$
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7.
Other sources of income to assist in college expenses
$$
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Anticipated Source(s):
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8.
Family contribution to estimated college expenses
$$
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9.
Please explain any unusual circumstances (emergency or medical expenses, debts on farm or business, etc.)
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VI.
LEADERSHIP & COMMUNITY SERVICE
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1.
Are you currently or have you been a member of the FFA ?
If no go to item 2.
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YesNo
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a.
Have you ever served as a national, state or chapter FFA officer?
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b.
List major FFA activities (offices held, committee assignments, awards, competitions, etc.) and the
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level of participation.
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One entry per line Do not duplicate any activities.Level of Participation (type in year)
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ActivityLocal/ChapterRegionalStateNational
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