Scholarship%20application%202015

APPLICATION Gordon R Brown Scholarship For Students from Lonoke County Enrolled in the College of Agriculture/Home Economics University of Arkansas or Arkansas State University Sophomore or Higher

Deadline for application is June 12, 2015 Please submit by way of email to Barbara.Chivers@afbic.com Or You may mail to LONOKE COUNTY FARM BUREAU PO Box 920 Lonoke, AR 72086 If you have questions, please contact Barbara Chivers @ 501-676-3111

Gordon R Brown Scholarship Date: Name: STUDENT IDENTIFICATION # Local Address: Permanent Address: Cell Phone #

Parent Phone #

Please indicate: Sophomore - Junior - Senior University of Arkansas or Arkansas State University Are you enrolled as a full time student?

How many hours do you plan to take this next semester?

Total number of hours completed?

Major: Minor: Semester GPA: Parents Name:

Cumulative GPA:

Parents Address: High School Attended: Year Graduated: High School GPA: Class Rank: Were you a member of 4-H? If so, Club Name: Offices held: Were you a member of FFA? Offices held: Agriculture Teacher: Were you a member of FCCLA or FHA? Offices held: Consumer Science Teacher: Other High School and/or College Organizations you have participated in and offices held:

Have you applied for financial aid or other scholarships?

Which ones?

Percentage of financial responsibility for your education You: % - Parents: % Are you employed?

If so, where?

What are your duties?

Are you married?

If so, is your spouse in school?

Number of dependents: If you are a dependent of your parents, please answer the following: Parents occupations?

Number of siblings in the family: Number of siblings presently in college: Please list special qualifications or reasons for applying for this scholarship, including financial need and/or any additional information that may be helpful in evaluating your application.

What are your career plans?

Do you give the Gordon R Brown Scholarship Committee permission to verify the information you have provided?