1 Amy Tippetts Wright Memorial Scholarship Application

Last Name: Click here to enter text. First Name: Click here to enter text.

Current mailing address (Street or P.O. Box): Click here to enter text. City: Click here to enter text. State: Click here to enter text. Zip Code: Click here to enter text. Phone: Click here to enter text. Current email: Click here to enter text.

Permanent mailing address (IF different from above): Click here to enter text. City: Click here to enter text. State: Click here to enter text. Zip Code: Click here to enter text. Phone: Click here to enter text. Permanent email: Click here to enter text.

Date of Birth: Click here to enter text. Place of Birth (City and State): Click here to enter text. If NOT born in Wyoming, please list number of years of residency: Click here to enter text.

The purpose of this scholarship is to benefit graduates of Lovell High School Are you a graduate of Lovell High School, Wyoming? ☐Yes ☐No Have you graduated? ☐Yes ☐No If yes, when did you graduate (month/year)? Click here to enter text. If no, when will you graduate (month/year)? Click here to enter text.

Name of educational institution you expect to attend this coming year (If undecided, please name the institution you most want to attend): Click here to enter text.

Are you currently enrolled in a post-secondary, accredited educational institution (university, community college, trade/technical school)? ☐Yes ☐No If yes, name of institution: Click here to enter text. If yes, current standing: ☐Freshman ☐Sophomore ☐Junior ☐Senior ☐N/A

What is your Major Field of Interest? : Click here to enter text.

Mail completed application form to:

Wyoming Community Foundation 1472 N. 5th Street, Ste. 201 Laramie WY, 82072 2

If you have been employed, please list the past 4 years: Supervisor’s name Company/Organization Type of work Dates Hours/Week

If you are applying, or intend to apply, for any other scholarships, aids, or grants, please list them: Name of program/scholarship Amount Requested Date of notification (if known)

List high school (or college) activities you participated in (debate, band, sports, student organizations, etc.): Activity Freshman, Sophomore, Junior and/or Senior Yr.

List community activities you participated in (church, scouts, 4-H, theatre, volunteer work, etc.): Activity Years of participation

List all honors, prizes, or special recognitions you have received with dates awarded (academic): Honor, prize, or recognition Dates awarded

Mail completed application form to:

Wyoming Community Foundation 1472 N. 5th Street, Ste. 201 Laramie WY, 82072 3

Name five courses from your recent schooling which you feel have best prepared you for college and/or your chosen major, and why: 1. Click here to enter text.

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From your daily classroom work or your extra-curricular activities in or out of school, what were the accomplishments in which you took pride? Please explain. (This might be a research paper, a project, or an area in which you accepted special responsibility.): Click here to enter text.

Is there anything else you would like to tell us about yourself that might aid the Selection Advisory Committee in considering your application? Click here to enter text.

ESSAY REQUIRED: Please attach a Word document. Limit your response to two (2) pages, typed in Times New Roman in 12-point font, double-spaced and single-sided. Answer the following:  How have overcome a significant physical, emotional, or social disability and how will you achieve success?

Mail completed application form to:

Wyoming Community Foundation 1472 N. 5th Street, Ste. 201 Laramie WY, 82072 4 Financial Aid Affidavit

Please provide the following information. All information will be kept confidential. This Affidavit is REQUIRED to be signed and dated upon submission.

Annual cost of attending the college you have chosen: Tuition $ Books and Fees $ Room and Board $ Transportation $ TOTAL $

Estimated annual dollar amount of money you will have available from savings and job earnings to apply towards the cost of your education. Include amounts that you (the student) will contribute as well as your parents, if applicable: Savings $ Job Earnings $ Parents Net (Combined) $

Mother’s Name: Click here to enter text. Mother’s Occupation: Click here to enter text. Address: Click here to enter text. City/State/Zip: Click here to enter text. Phone Number (Business): Click here to enter Phone Number (Home): Click here to enter text. text.

Father’s Name: Click here to enter text. Father’s Occupation: Click here to enter text. Address: Click here to enter text. City/State/Zip: Click here to enter text. Phone Number (Business): Click here to enter Phone Number (Home): Click here to enter text. text.

Number of dependents claimed on your parents’ most recent tax return: Are any of these family members attending college? ☐Yes ☐No If yes, where are they attending? Click here to enter text.

All the information above constitutes my application for this scholarship and is true and correct to the best of my knowledge and belief. If awarded this scholarship, I agree to abide by all its requirements. As the applicant, I understand that all information will be furnished to the Selection Advisory Committee, and shall be confidential.

Date: Click here to enter text. Signed: (Signature of applicant, written in ink)

Mail completed application form to:

Wyoming Community Foundation 1472 N. 5th Street, Ste. 201 Laramie WY, 82072 5

Send completed application and attach required essay

Mail completed application form to:

Wyoming Community Foundation 1472 N. 5th Street, Ste. 201 Laramie WY, 82072