Phillips County Motor Sports, Inc. And Hi-Line Drag Strip

A non-profit entity to promote economic development, education and tourism in  Phillips County

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Phillips County Motor Sports, Inc. 

And Hi-Line Drag Strip

Scholarship Application

2013 Academic Year

Four $500.00 scholarships to 2013 graduates

Applicant________________________________________________

                   Last name                      First name                      Middle initial

The check will be made payable to the school of your choice, after the completion of your first semester.

Deadline:  April 15, 2013

Submit completed application and official transcripts to:

Phillips County Motor Sports, Inc.

Scholarship Committee

P O Box 31

Malta MT 59538

Telephone 406-654-1132/2430  

APPLICATION

NAME ___________________________________________________________________ 

            LAST                                                     FIRST                MIDDLE                       

ADDRESS__________________________________________________________________

PHONE___________________________SOCIAL SECURITY #_______________________

DATE OF BIRTH________________

RESIDENT OF_________________________COUNTY

EDUCATION:

HIGH SCHOOL NAME/COUNTY_________________________________________________

DATE OF GRADUATION______________________

EVALUATION INFORMATION

State your educational career goals and why you want to attend a college, vocational or state-licensed trade school with the emphasis on automobile related training. Be specific.

List school related participation in extracurricular activities for the past three and one-half years. (Briefly) Include years of participation for each activity.

List community activities you have participated in for the past three and one-half years.

List your achievements or any special awards you have received for school or related activities.

List your employment record.

Reason for financial need.

Additional comments, which may be relevant for committee consideration in evaluating.

Name of school you plan to attend:

First choice___________________________________

Second choice________________________________

Third choice__________________________________

Transcripts:  Be sure to include your academic transcript(s)

CERTIFICATION

I (we} understand that all answers to the preceding questions are true and complete.

I (we) understand than any false answers or deliberate omissions on this application may be grounds for rejection of same and withdrawal of any award granted. I (we) authorize investigation of applicant’s schooling and other activities, and release those persons or organizations from any and all liability and responsibility for any damages I  (we) may suffer as a result of this information. I (we) agree that I (we) will abide by all decisions made by the Scholarship Committee on behalf of Phillips County Motorsports, Inc. as they pertain to this scholarship application.

APPLICANT SIGNATURE                                               (DATE)

(PARENT/GUARDIAN SIGNATURE)                               (DATE)

Direct any questions and return this application to:

Phillips County Motorsports Inc.

Scholarship Committee

P O Box 31

Malta MT 59538

Telephone 406-654-1132/2430