Preston J. Juffer Memorial Scholarship

PRESTON J. JUFFER MEMORIAL SCHOLARSHIP

for

West Sioux Community High School Graduating Seniors

This scholarship is hereby established and provided for by the Preston J. Juffer Memorial Fund in accordance with the actions of the 1969 Board of Directors. It is to be awarded annually to a West Sioux Community School senior student graduating before June 15 of the current year.

The amount of the scholarship is ($1000) one thousand dollars to be paid to the institution at the beginning of the second semester after the first semester has been successfully completed in the case of a four or more year course or after one half of the training has been completed in the case of a trade school or courses which are less than fours years of duration.

Applications must be complete and submitted by April 1 to be considered.

In order that your qualifications may be considered by the committee, please fill out as completely as you can the questions listed here and return to the Iowa State Bank, Ireton, IA 51027.

Name________________________________________________________________________________

(Last) (First) (Middle)

Address_______________________________________________________________________________

(Street) (City)

Age___________________ Date of Birth____________________ Place__________________________

Parent's Name_________________________________________________________________________

Number of brothers and sisters ____________________

If you work part-time, where and when ____________________________________________________

Name and address of institution where you've been accepted:____________________________________

____________________________________________________________________________________

Professional endeavor for which you plan to study:___________________________________________

Accelerated classes in which you have participated:___________________________________________

GPA __________________ Class rank _____________________________________

Honors or other evidence of scholastic ability:

1. ________________________________________ 2. __________________________________

3. _______________________________________ 4. ___________________________________

Activities participated in during high school (all athletics, student government, music etc.)

Activity Position held

_________________________________________________________________________________

Community activities (church, scouting, 4-H, etc.) Give the years of the activity.

_________________________________________________________________________________

List two school personnel scholastic references:

1. ________________________________________________________________________________

2. ________________________________________________________________________________

List two community references who are well acquainted with your activities and character:

1. _______________________________________________________________________________

2. _______________________________________________________________________________

Write a short paragraph as to why you need and would like to receive this scholarship.

Please paste billfold size photo here.

______________ _________________________

date signature