<p> SOIL CONSERVATION SOCIETY OF AMERICA (SCSA) Scholarship Application Form</p><p>Murray State College Foundation Tishomingo, Oklahoma 73460</p><p>This $500/year scholarship is restricted to second-year students majoring in agriculture who are interested in pursuing an education in agricultural land use. Applicant must maintain a 2.5 GPA and be enrolled full-time (12 credit hours) to receive second semester award.</p><p>INSTRUCTIONS: Please read the following information carefully and fill in all blanks.</p><p>1. Please print or type all information and attach an additional sheet if more space is required. 2. For scholarship consideration this application must be brought or mailed to: Murray State College Foundation, One Murray Campus, Tishomingo, OK 73460. 3. Deadline for receiving application materials is April 1.</p><p>The application must be complete to be considered. The scholarship will be awarded on the basis of information in the application.</p><p>(MR/MRS/MISS/MS): ______LAST NAME FIRST MI Street Address: ______City: ______State: ____ Zip: ______Phone: (____) ______Date of Application: ______SSN: ______Marital Status: __ Single; __ Married; __ Divorced. If married, is your spouse a student? ______U.S. Citizen? __ Yes __ No; Permanent U.S. Resident __ Yes __ No Name of high school: ______Number in high school class: ______High School GPA: ______College GPA: ______County: ______Year of Graduation: ______College Major: ______ACT Composite Score: ______College Address: ______Phone: (____) ______Parent/Guardian: ______LAST NAME FIRST MI Street Address: ______City: ______State: ____ Zip: ______Phone: (____) ______</p><p>D:\Docs\2018-01-08\0f3f2858e013e02575eedd5334228048.doc Revised 1-17-14 THREE REFERENCES WHO ARE NOT RELATED TO YOU:</p><p>1. (MR/MRS/MISS/MS): ______Last Name First MI Street Address: ______City: ______State: ____ Zip: ______Phone: (____) ______2. (MR/MRS/MISS/MS): ______Last Name First MI Street Address: ______City: ______State: ____ Zip: ______Phone: (____) ______3. (MR/MRS/MISS/MS): ______Last Name First MI Street Address: ______City: ______State: ____ Zip: ______Phone: (____) ______</p><p>Please attach a high school transcript and/or college transcript and the following information (TYPEWRITTEN): A. List your high school/college activities and/or offices held in organizations. B. Make a brief statement regarding your work experience. C. Make a statement regarding your financial needs. D. Provide a statement which describes your career goals.</p><p>I HEREBY CERTIFY THAT THE INFORMATION SUBMITTED IN THIS APPLICATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE. I GRANT PERMISSION TO THE SCHOLARSHIP COMMITTEE MEMBERS TO REVIEW AND VERIFY CONTENTS.</p><p>______SIGNATURE OF APPLICANT</p><p>D:\Docs\2018-01-08\0f3f2858e013e02575eedd5334228048.doc Revised 1-17-14</p>