<p> JOHN A. JOHNSON SCHOLARSHIP FOUNDATION APPLICATION FOR SCHOLARSHIP AWARD</p><p>Wells Fargo Bank Montana, N.A., as Trustee for the John A. Johnson Scholarship Foundation, is seeking applicants for scholarships. The Scholarships are available:</p><p>To one or more students in the graduating class at Anaconda High School or graduates thereof, as an aid and inducement to further the education of such recipient(s) at any recognized college or university of choice.</p><p>This form should be completed by the applicant and submitted WITH A POSTMARK NO LATER THAN APRIL 1st, a copy of the applicant’s transcript; three (3) character references, only one of whom is associated with the applicant’s high school or college; and a completed Financial Data Form (attached). Please submit all forms to:</p><p>Anaconda Public Schools AHS Counseling Office Joe Casey 515 Main Street Anaconda, MT 59711</p><p>Applications should be typed or neatly printed.</p><p>Date of Submission Social Security Number</p><p>Applicant’s Name</p><p>Address</p><p>City, State Zip</p><p>Date of Birth Place of Birth</p><p>Father’s Name Father’s Occupation</p><p>Mother’s Name Mother’s Occupation</p><p>Guardian’s Name (If other than Parent) Guardian’s Occupation</p><p>Address of Parent/Guardian (If different from yours)</p><p>Date of Graduation from High School</p><p>Number in Class Rank in Class G.P.A.</p><p>1 High Schools previously attended:</p><p>Name: Place: Years: Honors in high school or other schools</p><p>High school activities</p><p>Out of school activities</p><p>Summer and part-time employment</p><p>2 JOHN A. JOHNSON SCHOLARSHIP FOUNDATION</p><p>In 200 words or less, please summarize your higher educational objectives and career goals, stating why you have chosen as you have and how this scholarship will help you achieve your goals.</p><p>3 If awarded the John A. Johnson Foundation Trust Scholarship, I agree to attend the following school of my choice for the one-year term of the award.</p><p>Address:</p><p>I understand that if I do not complete a one-year period that I will reimburse the Foundation a pro rata share of my award.</p><p>I understand that the scholarship funds are for the payment of:</p><p>1. Tuition 2. Fees 3. Board and room, and 4. Books and other study materials</p><p>I understand that the funds cannot be used for travel expenses.</p><p>I will submit to Wells Fargo Trust and Investment Center, Attention Sharon M. Ayers, P.O. Box 95021, Henderson, NV 89009-5021 the following:</p><p>1. Each quarter/semester a transcript of grades 2. An accounting of expenses</p><p>I understand that the John A. Johnson Foundation Trust Scholarship can be terminated for lack of diligence and success on my part or failure to quarterly account for scholarship funds in a manner determined by the Trustee.</p><p>Dated this ______day of ______, 2013 Sincerely,</p><p>______Applicant’s Signature FINANCIAL DATA FORM</p><p>Estimate of Funds Needed During Ensuing College year:</p><p>Tuition and Fees______Books and Supplies______</p><p>Room and Board______Personal Requirements______</p><p>4 TOTAL NEEDED $______</p><p>Expected Personal Financial Resources During Ensuing College Year (Income from these or any other sources will not disqualify the applicant, but will be considered along with other factors):</p><p>Savings or other funds on hand______</p><p>Scholarships______</p><p>Parents______</p><p>Employment______</p><p>Other______</p><p>Total Funds Available $______</p><p>Total Needed less Total Available $______</p><p>5</p>