Dallas E. Heckt

APPLICATION FOR DALLAS E. HECKT SCHOLARSHIP

One scholarship of $500 will be given from the Trustee, under the will of Dallas E. Heckt, to a graduating senior at West Sioux High School, who will attend college in the fall. For consideration, please complete and return this form to your school counselor by April 1. The winner will be announced at your school's commencement exercises

1. Name:_____________________________________________________________________________

Address:___________________________________________________________________________

City, State ZIP:______________________________________________________________________

Telephone Number:__________________________________________________________________

Social Security Number:_____________________________________________________________

Parents Name:______________________________________________________________________

2. I intend to enter________________________________________________________in the fall.

3. What are your reasons for continuing your education?_______________________________________

____________________________________________________________________________________

4. Which field of study/vocation do you plan to pursue?________________________________________

____________________________________________________________________________________

5. Why have you chosen this field/vocation?_________________________________________________

____________________________________________________________________________________

6. How do you plan to finance your education?_______________________________________________

____________________________________________________________________________________

7. Why do you want this scholarship?______________________________________________________

___________________________________________________________________________________

____________________________________________________________________________________

8. School activities you participated in during high school:______________________________________

____________________________________________________________________________________

9. Community activities you participated in during high school:__________________________________

____________________________________________________________________________________

10. Please attach a copy of your transcript.