Double El/Agate Conservation Districts

Serving landowners in parts of Elbert, El Paso and Lincoln Counties

P.O. Box 215, 504 Washington Simla, CO 80835 Phone: 719-541-2359 Fax 719-541-3061

                             cherylchurchscd@att.net                           

High School College Scholarship

The Double El Conservation District (CD) is pleased to announce that it will offer a scholarship of $1000 to provide financial assistance to a high school senior to attend an approved college, university, junior college or trade school. A renewable option of $500 will be provided to the scholarship winner upon verification of 3.0 GPA following the first year of completed college.

 An official college transcript must accompany request for $500 renewable option.

The Scholarship award will be paid to the appropriate office of the college or university attended. Disbursement of the funds for

trade schools will be negotiated with the school by the Double El CD office.

A committee appointed by the Board of Directors of the Double El CD will select the scholarship recipient.

Scholarship winner will be selected on the basis of leadership qualities, high school activities, financial need, academic record, character and sincerity.

1. Applicant must be a high school senior.

2. Applicant must have a "home address" within the boundaries of the Double El CD.

3. Applicant will receive points if their parents are cooperators of the Double El CD.

4. A high school transcript must accompany the application.

5. Two letters of recommendation must accompany the application. One letter must be from a

school faculty member who has had the applicant as a student.

6. A letter from the applicant to the Double El CD committee must accompany the

application. (See item # 10 of the application) This is one of the most important items of

7. Application for the scholarship must be postmarked no later than April 15.

8. Applicant must attend an approved college, university, junior college or trade school.

9. The scholarship winner will be announced by May 30.

10 The recipient must notify Double El CD office of acceptance or refusal of the scholarship in

writing by June 15^th of the year received or the scholarship will be passed to an alternate.

Applicant’s name:_______________________________________________________

Applicant’s Number:_________ (To be completed by Double El Conservation District)

Social Security #:______________________

Telephone #__________________________

Home Address:__________________________________________________________

Name of High School:_____________________________________________________

Parents or legal guardians names:

Father or Legal Guardian:____________________________________________

Mother or Legal Guardian:___________________________________________

List the names and complete addresses of the two people who have submitted written recommendations,

which are attached to this application form:

Name:__________________________________________________________________

Name:__________________________________________________________________

I certify that to the best of my knowledge the information provided in this application is true and correct

________________________________ _________________________________

Applicants Signature:                        Date:

Applicant Number:_________ (To be completed by Double El Conservation District)

High School Grade Point Average: ______

Year of Graduation: ______

ACT / SAT Score: ______

1. I certify I live within the Double El CD boundaries: (legal description of property)

______________________________________________________________________

2. Proposed college major and tentative plans upon completion of college.

________________________________________________________________________

3. Are your parents’ cooperators within the Double El Conservation District?

(Circle One) Yes - No

4. How are your parents involved in natural resource conservation?

5. Attach sheet with list of activities participated in, offices held, and awards received while in high school.

6. Attach sheet with list of other interest and activities: (church, community, etc.)

7. Submit one official copy of your high school transcript.

8.  List scholarships and/or grants for which you have applied

(attach additional pages if needed)

________________________________________________________________________

________________________________________________________________________

9.  Following is my estimated budget for June 2009 to May 2010

Expenses and Income:

Tuition & Fees: $___________             Wages: Summer: $___________

Room & Board: $___________             Wages: Fall Semester: $___________

Book & Supplies: $___________           Wages: Spring Semester: $___________

Personal Expenses: $___________       Parental Support: $___________

Other Expenses: $___________              Other Income: $___________

Total Expenses $___________               Total Income: $__________

Write a narrative describing your educational and/or vocational plans and give any other information or circumstances

(e.g. financial need) that would be helpful to the committee in determining your need and qualification for this scholarship over the other applicants.

Attach an additional page if necessary.  ( THIS IS ONE OF THE MOST IMPORTANT PARTS OF YOUR APPLICATION CONSIDERATION)