Mark Carpenter Memorial Scholarship

Application

Name of applicant ________________________________________________Phone__________

Address: (Street/Box)___________________(City)_________________(State)___(Zip)________

Age____Date of Birth____________SS Number_________________DL Number_____________

Name and address of parent or guardian ______________________________________________

______________________________________________________________________________

Occupation and employer__________________________________________________________

High School ______________________________ Date of graduation ______________________

Numerical grade average ___________SAT Score____________ ACT Score ________________

College you plan to attend ________________________________________________________

Have you been accepted?_________________When do you register?_______________________

Course of study you plan to pursue? _________________________________________________

How many years have you participated in the Texas Citrus Youth Show? ____________________

Please give a brief description of your school extracurricular activities, including but not limited

to FFA, 4-H, volunteer work, church work, sports, clubs, etc. (Use a separate sheet if needed).

______________________________________________________________________________

List any awards, honors, recognitions, or offices held. (Continue list on separate sheet if needed.)

______________________________________________________________________________

Please list the names and addresses of three persons who would serve as personal references.

______________________________________________________________________________

I hereby certify that the statements contained in this application are true, accurate and complete.

Signature of Applicant _____________________________________ Date _________________

This completed application and the essay must be submitted before the closing time for fruit
exhibits at the Texas Citrus Fiesta Youth Show site.