.

STUDENT'S FULL NAME      
STUDENT'S ADDRESS      
     
FATHER'S NAME & OCCUPATION      
     
NUMBER & AGE OF SIBLINGS AT HOME      
NUMBER OF FAMILY MEMBERS IN COLLEGE      
A. GPA	     
CLASS RANK	     
     
     
     
     
     

Norton Scholarship

HIGH SCHOOL SENIOR APPLICATION FORM

TONY AND MARTHA NORTON MEMORIAL SCHOLARSHIP

DATE & PLACE OF BIRTH

MOTHER'S NAME & OCCUPATION

I. ACADEMICS (include a copy of high school or college transcript, whichever is applicable)

out of

students.

B. Have you taken all required course work at your high school?

Yes

No

C. List any courses taken at other high schools in the Silver Valley.

II. VOLUNTEER COMMUNITY SERVICES (snow shoveling, helping elderly, community
clean-up other than the school-sponsored day, yard work, volunteering to assist with city
projects, please be specific.)

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III. HONORS AND AWARDS RECEIVED IN HIGH SCHOOL

IV. LEADERSHIP (Offices held in class or school organizations)

V. PARTICIPATION IN EXTRACURRICULAR SCHOOL ACTIVITIES

VI. OUT-OF-SCHOOL ACTIVITIES (i.e., hobbies, Scouts, church groups, etc.)

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COURSE OF STUDY:      
CAREER GOAL:      
$      
$      
$      
     
$      
$      
$      
LAUNDRY/CLEANING	     
$      
$      
$      
$      
$      

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VII. POSITIONS HELD IN GAINFUL EMPLOYMENT AND PERIODS OF EMPLOYMENT

COLLEGE YOU PLAN TO ATTEND:

VIII. EXPENDITURES FOR COLLEGE:

FEES

TUITION

BOOKS & SUPPLIES

ROOM & BOARD

$

TRAVEL

CLOTHING

SOCIAL

$

OTHER EXPENSES

TOTAL

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IX. HAND-WRITTEN PERSONAL STATEMENT OF FUTURE GOALS
	(Use this page only)

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X.

WRITTEN STATEMENT FROM PARENTS OR STUDENT, ILLUSTRATING
APPLICANT'S NEED FOR FINANCIAL ASSISTANCE. THIS INFORMATION
WILL BE KEPT CONFIDENTIAL. (Optional)

XI.

LIST NAMES, ADDRESSES, PHONE NUMBERS AND RELATIONSHIP OF THREE
PEOPLE WHOM YOU HAVE ASKED TO WRITE YOUR RECOMNIENDATIONS.
THOSE WRITING RECOMMENDATIONS SHOULD NOT BE FAMILY MEMBERS
AND ONLY ONE MAY BE SCHOOL RELATED.

1.

2.

3.

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XII. EXPLANATIONS OR SPECIAL CIRCUMSTANCE
	Use the following space to explain concerns about any part of this form.

XIII. SIGNATURES (Both the student and parents must sign.)

DATE

SIGNATURE OF STUDENT

DATE

SIGNATURE OF PARENT

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Date:	     
Signature:      
Position:	     

Norton Scholarship

	CONFIDENTIAL REPORT ON CANDIDATE FOR
TONY AND MARTHA NORTON MEMORIAL SCHOLARSHIP

Dear Sir or Madam:

Your name has been submitted as a reference for

who is

being considered for a college scholarship. university. Your assistance in helping to select worthy candidates will be appreciated.

	In your opinion, is the above-named person fully qualified as to scholastic ability,
character, and leadership to merit an award of this kind. Please explain: (Use other side if more
space is needed).

Recommendations must be postmarked no later than  February 16. Mail to:

Tony  and Martha Norton Memorial Scholarship
Kellogg High School
#2 Jacobs Gulch
Kellogg, Idaho 83837
Attn:  Bob Grigg, Counselor

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