MT Clerk & Recorder's Scholarship
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MONTANA CLERK & RECORDER'S
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SCHOLARSHIP APPLICATION FORM
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AMOUNT OF SCHOLARSHIP
$1,000.00 First Place Winner
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$500.00 Second Place
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APPLICANT MUST BE A GRADUATING SENIOR WHO WILL BE ATTENDING
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AN IN STATE SCHOOL.
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This Application for the Clerk & Recorder's Scholarship becomes
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complete and valid only when you have returned the following
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materials:
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Application
All required signatures
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Current Transcript of Grades
Application deadline: March 13, 2020
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Return completed application to:
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Robin A. Benson
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Lincoln County Clerk & Recorder
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512 California Avenue
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Libby, MT 59923
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Or deliver in person to the Clerk & Recorder's Office located 512 California Ave., Libby
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Updated 12/30/2019
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APPLICANT INFORMATION
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County:______________
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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)
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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 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)
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Address
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(street)(city)
(state)
(zip)
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Name of post-secondary school for which applicant's scholarship is requested
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4 yr College/Univ
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Community College
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Address
Accredited? Yes
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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.Day
Year
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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.Day
Year
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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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