Scholarship Application

SCHOLARSHIP INFORMATION: Applications must be received no later than 5/1 to be considered. Awards of up to $1,000.00 will be given based on the information contained in the application submitted. Payment of awards are contingent upon the successful completion of at least one semester (for new enrollees, this will be your first semester). Awards can vary each year depending on available funds and the number of applicants. Awardees will be notified by email of the award no later than 7/1 annually. If you are selected to receive an award and accept, payment will only be made following the receipt of verification of successful completion of at least one semester. Email verification to farmers@crocker.com. Checks will be executed/mailed to the recipient(s) listed above.

Applicant Name
Date of Birth
Residential Address
Mailing Address (if different)
Best Tel. # for you
E-mail
Agriculture related major/program you are pursuing:
Schools, colleges, institutions or training program you are either currently enrolled in OR have applied to and what your acceptance status is:
School Name & Status
School Name & Status
School Name & Status
School Name & Status
If you are currently enrolled in OR have decided and accepted what school/program you will attend, list the name and date of your enrollment/acceptance.
Name
Date

APPLICATION DIRECTIONS: In no more than 300 words, tell us what your future plans are for a career in agriculture. Please also include any agricultural experience you have had and why you have chosen to pursue a path of study in agriculture. Explain why you believe you should be considered for this scholarship. Use the space on the following page for your response.

By digitally signing the application below, I attest that the information listed above is true and that I have completed the application myself.
Applicant Signature
Date

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