SCHOLARSHIP APPLICATION

Name: Click or tap here to enter text.

Address: Click or tap here to enter text.

City: Click or tap here to enter text.	Zip Code: Click or tap here to enter text.

Phone: Click or tap here to enter text.	Email: Click or tap here to enter text.

Parent’s Name: Click or tap here to enter text.

Do you have a family member who is an IEHA Member: ☐ Yes ☐ No

If yes, the name of the member: Click or tap here to enter text.

Name of High School: Click or tap here to enter text.

Rank in Class: Click or tap here to enter text.	Class Size: Click or tap here to enter text.

GPA: Click or tap here to enter text.

College Entrance Test: ☐SAT ☐ACT ☐ASSET ☐COMPASS Score: Click or tap here to enter text.

If you are a current high school student, list your extra-curricular and outside of school activities. If you are a non-traditional student, list your past 4 years of work experience and any other activities that are important to you: Click or tap here to enter text.

College will you be attending: Click or tap here to enter text.

Have you been accepted by this school? Click or tap here to enter text.

If yes, contact information: Click or tap here to enter text.

Student ID # Click or tap here to enter text.

ESSAY: On another sheet of paper, type an essay of approximately 250 words (1 typed page, 11 or 12 font) explaining your career plans and goals.

FOR YOU TO BE CONSIDERED FOR A SCHOLARSHIP, YOU MUST ENCLOSE THE FOLLOWING DOCUMENTS:

Application filled out completely

Typed essay

Three letters of recommendation (no family)

High School transcript

Applications must be postmarked by February 1, 2020 and mailed to:

Sandy Bubke

Monona County Environmental Health

610 Iowa Avenue, Onawa, Iowa 51040