Leadership Program Application – Harness Horse Youth Foundation

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CURT GREENE MEMORIAL SCHOLARSHIP APPLICATION

Sponsored by the Harness Horse Youth Foundation (Please read Greene General Information page before completing this application)

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Father's Name*

Father's Occupation*

Mother's Name*

Mother's Occupation*

Number of Siblings*

Number of Siblings in College*

Current Year in High School or College*

College you are/will be attending*

Degree you will be pursuing*

Grade Point Average*

SAT or ACT scores*

Have you completed the FAFSA for the upcoming year?*

If yes, did you qualify?

List all scholastic honors and achievements you have received in the past 4 years*

List sports, groups, clubs, community and/or volunteer activities you have participated in the past 4 year*

Work Experience

Company*

Date From*

Date To*

Hours Per Week*

Hourly Rate*

Company*

Date From*

Date To*

Hours Per Week*

Hourly Rate*

How do you plan to finance your college expenses for the upcoming year? Please be specific.*

What scholarships have you applied for in the upcoming year? If you have received any scholarships to-date, provide scholarship name(s) and amount(s).*

How much of your college expenses will be covered by personal or family contributions?*

Are there any unusual family or personal circumstances that you would like the selection committee to consider which have affected your school activities, work experience or achievements? (100 words or fewer)*

What are your career goals and ambitions? (250 words or fewer):*

[VIDEO QUESTION] How has your association with harness racing been a positive influence on your life? (2 to 4 minutes in length)*

Max. file size: 2 GB.

Names of Letter of Reference*

I hereby give the Harness Horse Youth Foundation permission to utilize this information for the purpose of public relations. I certify that I am a full-time student and will use this scholarship toward expenses for my educational expenses. By signing this application, I certify the above information is complete and accurate to the best of my knowledge. Falsification of information may disqualify me from consideration of a Harness Horse Youth Foundation scholarship. Upon submission, all application materials are the property of the Harness Horse Youth Foundation.

Upload Documents*

Drop files here or

Max. file size: 2 GB.

Signature of applicant*

Date*

Phone

This field is for validation purposes and should be left unchanged.

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