Application for the 2012 Award of The Vennard Gilmore Scholarship

Your Contact Information:
Full Name: __________________________________________ Email Address ________________________________________
Mailing Address: __________________________________________ Phone Number: ________________________________________
  __________________________________________    
  __________________________________________    


Your Education Status:
Actual or anticipated date of high school graduation: Month_________     Day_________     Year_________
GPA: What is your cumulative GPA? _________
  What was your Junior year GPA? _________
  What is your 1st semester Senior year GPA? _________
Honors you have received (Dean's List, Honor Society, etc.), and participation in extra-curricular / volunteerism activities: _______________________________________________________________
_______________________________________________________________


College Plans:
Name of the college you plan to attend:
_______________________________________________________________
College Mailing Address: _______________________________________________________________
  _______________________________________________________________
College Website Address: _______________________________________________________________
College Registrar Phone Number: _______________________________________________________________
   
What is the first day of classes that you will attend?  
Month_________     Day_________     Year_________
Will you attend full-time (12 or more credit hours per term)?
 Yes___________     No__________
Note: only full time students are eligible for this scholarship.  
What major or area of interest do you intend to pursue? _______________________________________________________________


Your Family Connection to a Vennard Alumnus:
(A Vennard alumnus is anyone who attended or taught at one of the Vennard colleges.)
Name of the Vennard alumnus: _______________________________________________________________
The years they attended/taught, and the name of the college -- Vennard, Wesley Bible (HMST), CEI, Kletzing,
John Fletcher, CHU :		 Years Attended __________________________________________________ 
College Name____________________________________________________
How are you related to this Vennard alumnus? _______________________________________________________________
Contact information for this Vennard alumnus:
Email (preferred), phone or mailing address:		 _______________________________________________________________
  _______________________________________________________________


Date:   ___________________________________        Signature:_______________________________________________________