Miner St. Meat Market Scholarship Application

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1 Miner St. Meat Market Scholarship Application Student Name Name of High School Parent/Guardian Name Phone Address City Name of College for Fall Enrollment College Address City Zip The following information will be used to determine scholarship recipients. Please be complete, truthful and accurate with information. Senior Project Topic and Mentor Academic Information Please check the appropriate columns for awards received during your Junior or Senior years ONLY Jr. Sr. Student of the Month (list each award) Student of the Year (list department) C.S.F. Membership Top 100 Rotary Student of the Month Girls or Boys State Scholar Athlete Award National Honor Roll Golden State Exam Recognition Awards Top Junior or Senior Please list any other ACADEMIC awards or honors received during your Junior or Senior years ONLY 1

2 Community Service Information Please list any COMMUNITY SERVICE you performed that is not school related. Limit this to your JUNIOR and SENIOR years ONLY. This would include any volunteer work, church youth groups and related work projects, 4-H, or any areas of community leadership. Name of Organization Type of Work Supervisor Describe how you have made our community a better place for others: 2

3 Agriculture Related Information Please list any Agriculture related activities you have been involved in. Are you a member of F.F.A. Yes No (Circle One) Are you an elected officer for F.F.A. (list offices held during Jr. and Sr. Year only) _ Please describe your future plans for involvement in Ranching, Farming or other Ag related activities. 3

4 Extra Curricular Activities Sports Please check any Varsity Sports you completed a full season of participation during your Junior and Senior years ONLY. Jr. Sr. Sport Football or Volleyball Soccer Basketball Baseball or Softball Cross-Country Track and Field Ski and Snow Board Team Tennis Other (must be school sport NOT club) List any TEAM awards received during those seasons listed above (MVP, Most Improved etc. as voted on by team or coaches) List any LEAGUE awards received List any SECTION awards received List any other club sport related athletic participation, awards or honors. Clubs Please list all school sponsored club participation during your Junior and Senior years ONLY. 4

5 Please check each elected office you held. Student Government Jr. Sr. Office Student Senator Class Officer (Jr./Sr. Pres., V.P. or Treasurer) A.S.B. Commissioner A.S.B. Elected Officer (Pres., V.P. or Treasurer) Drama or Performing Arts Please list each area of participation during your Junior and Senior years ONLY. Other Extra-Curricular Activities List any other School-Related extra curricular activities. This may include areas such as peer tutoring, peer counselors etc. Certification-All Signatures Required By signing this form, you are stating the above information and all related documents are true and correct. Students Signature Counselor Signature Parents or Guardian Signature This Application MUST BE accompanied by: 1. Current Transcript showing all years of high school. 2. Top page ONLY of FAFSA form showing EFC number. 3. Two letters of reference from non-family members. 5

6 Miner St. Meat Market Siskiyou Distributing Scholarship Application In an effort to promote local Agriculture involvement and support local farming and ranching families, Miner St. Meat Market and Siskiyou Distributing are proud to offer two $500 scholarships to graduating seniors from Yreka High School and Etna High School. Each year a deserving boy and girl from each school are selected to receive this prestigious award. The selection is based on five areas: Academic achievement, Community Service, Extra- Curricular School Activities, Financial Need and involvement in Agriculture related activities. Applicants are awarded points for participation and achievement in each area. Financial need is determined by the Estimated Family Contribution Score from the FAFSA form. Interested students may obtain applications directly from Siskiyou Distributing or ing info@siskiyoudistributing.com. Care should be taken to submit complete and accurate applications as well as ALL supplemental documents that are required. Completed applications with all related documents must be submitted by the closing date of Monday, May 16, Please make sure you have all signatures needed on these forms by the due date. If you have any further questions feel free to contact: Ken Barnes c/o Siskiyou Distributing 1313 N. Foothill Dr. Yreka, CA Completed Applications may be submitted to: Siskiyou Distributing 1313 N. Foothill Dr. or Miner St. Meat Market 200 W. Miner St. 6

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