3D"NAPUS = &nb= sp; = &nb= sp; &= nbsp;

APPLICATION FOR WISCONSIN NAPUS SCHOLARSHIP

Fill in each blank with informa= tion requested. Use N/A if questio= n is not applicable to you.

PERSONAL INFORMAT= ION

Stud= ent’s Full Name ________= ______________________________ Social Security # ________________

Perm= anent Address __________= ______________________________________________________________

Date= of Birth __________________= ____ Telephone Number _________________= ____

Date Graduated or will Graduate = ; ______________ Rank in Class ______ of ______ (Class size)

Name= & Address of High School &nb= sp; ________________________________________= ____________________

Name= of Principal &nbs= p; __________________________ Name of Counselor ________________________

Name of Postmaster that qualifies you for this scholarship __________________________________________

__Active Member &nbs= p; __Retired __Deceased &= nbsp; Office ____________________________________

Your Relationship to this Postmaster ____________________________________________________________

Father or Guardian &= nbsp; &nbs= p; &= nbsp; Mother or Guardian

Name &nb= sp; = _____________= _________________ &= nbsp; &nbs= p; ______________________________

Address = &nb= sp; ____________________________= __ &= nbsp; &nbs= p; ______________________________

Occupation &nb= sp; = ______________________________ &= nbsp; &nbs= p; ______________________________

Employer = ; &n= bsp; ______________________________ &= nbsp; &nbs= p; ______________________________

How many siblings receive support from your parents? ____= How many currently attend College? ____

List any scholars= hips, grants or loans you will be receiving

Scholarships &= nbsp; &nbs= p; Source __________________________________________&= nbsp; Amount __________

Grants &= nbsp; &nbs= p; Source __________________________________________&= nbsp; Amount __________

Loans &n= bsp; = ; Source __________________________________________&= nbsp; Amount __________

APPLICATION FOR WISCONSIN NAPUS SCHOLARSHIP (Page 2 of 3)

Do you plan to live at school or commute? _______________________= _______________________________

Do you plan to work during college? = __No __Part-time __ Full-time=

Previous Work Rec= ord (Account for all positions sinc= e the age of 16 years old)

Place of Employment = &nb= sp; = &nb= sp; Hours per Week = ; &n= bsp; Employment Term

_____________________________________ __________= ___ &= nbsp; &nbs= p; ________________________

What College, Uni= versity or Trade School do you plan to attend? = ; &= nbsp; ______________________________<= o:p>

School’s Mailing Address _____________________________________________________________________<= /o:p>

Have you applied for admission? ______ Have you been accepted? ______ Cost of annual tuition $_________

Have you taken SAT test?= _______ Date ___________ = Total Score __________

Have you taken ACT test?= _______ Date ____________ Total Score __________

What scholastic honors have you received? (State year and nature)= ____________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ____________________________________________________

What extracurricular honors and awards have you received? = _______________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ______________

What civic honors and awards have you received? _______________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ______________

APPLICATION FOR WISCONSIN NAPUS SCHOLARSHIP (Page 3 of 3)

What offices and positions of leadership have you held? _______________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ______________

What activities, either school related or non-school related have you participated in ? _______________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= _________________________________________________

What hobbies do you have? _________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= _______________________________________________________________<= /span>

Who or what influenced you the most in deciding to obtain your college education? ___= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= __________________________________________

Other supporting documentation required for this application:

1. On an addit= ional sheet of paper, please write a biographical sketch discussing your plans for college, your vocation and the future.

2. Submit a co= py of your scholastic grades and attendance record.

3. Furnish an endorsement from a responsible person not related to you, who has had an opportunity to personally observe you, and who can offer a worthwhile opini= on of your character, and work ethic.

PARENT’S STATEMENT:

I acknowledge that I have read, underst= ood and agreed with this application information that my son/daughter has submitted.

_______________________________________= _____________ __________________=

Parent’s Signature &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; Date