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?