College Online Scholarship Application

College Student Application for Scholarship Assistance from the Merrick Foundation, Inc.
College student scholarships are available to college students whose permanent residence is in Merrick County.
Before beginning, please read through all the instructions, click here
(Failure to follow these instructions may result in your application being disqualified.)

Personal Data

Are you a Resident of Merrick County?: Yes No

If NO, list your county of residence:
First Name:
Last Name:
Address:
City:
State:
Zip:
Telephone:
Birthdate (mm/dd/yy):
Email Address:

Both parents' names & address(es) - names only if address is the same as above
Father:
Mother:

Educational Background/Program

1) From what high school did you graduate?
2) Date of high school graduation: Month: Year:
3) School you plan to attend during 2017-2018:
4) Address of school:
    Is this a 4-year college?
    Is this a 2-year vocational / technical college?
5) College/Department enrolled in (i.e. teaching, business, arts & sciences):
   
6) What is your major?   minor?
8) How many credit hours do you plan to carry?


Work Experience

List your past and present work experience:

Employer Address Date  Hrs/ week
 
 
 
 


References: 
(Please include only two letters unless more are required to meet criteria of scholarships applied for)

List individuals from whom you have requested letters of recommendation:

Name Address


Please check the appropriate box(es) below to the scholarship(s) you are applying for. You may qualify for scholarships in more than one category:
(Review complete list of available scholarships and requirements FIRST by clicking here.)

MERRICK COUNTY RESIDENTS OR STUDENTS ATTENDING 
MERRICK COUNTY HIGH SCHOOLS
Leonard and Doris Aerni Memoral Ralph Stanley and Ella Halstead 
      Severance Memorial*
American Legion 40 & 8 Scholarship Raymond W. Starostka Memorial
Hohnroth Family Scholarship William and Emma Steffen Nurses*
Vernie L. Lock Elwin & Lucille Ferris*
Albert & Dorothy Emgarten Memorial Austin and Cleo Vanderford*
Raymond, Leonard & Lois Steger Memorial Leanne Zmek Memorial*
Donald Nouzosky Memorial*  Jack and Dorothy Burger     
   


ARCHER VICINITY 

Virgil and Nora Lindner  


CENTRAL CITY 

Michael V. Bittinger Memorial Virgil and Nora Lindner
Myrtle and Jim Clarke*   
 
CHAPMAN 
Eugene Fishburn Scholarship  


CLARKS/CLARKS CONSOLIDATED 

Michael V. Bittinger Memorial Doris E. Neel Memorial*
Myrtle and Jim Clarke*  
 


PALMER 

Virgil and Nora Lindner Clinton M. Wegner*
Carole A. Joseph Memorial Dinsdale Sophomore Scholarship

RESIDENTS OF FULLERTON, HORDVILLE, POLK, OR LAKE AREAS SOUTH
OF CENTRAL CITY 
Myrtle and Jim Clarke*

(Scholarships with an (*) above are based on financial need. Please click here for Financial Need Information Form
If financial need information is not provided, you will not be considered for these scholarships. Remember to select the "back" button on your browser to return to this application once you have completed and printed the Financial Need form.)

Describe Your Campus Activities (volunteering, athletics, etc.): 


Church/Religious and Community Activities: 

Number of Years Active in 4-H:
Number of Years Active in FFA:


Essay:
Questions 1 & 2 below are required for all applicants. Please refer to the Scholarship Descriptions and Requirements Form to see which of the questions below are required for the specific scholarship(s) you have applied for and will need to cover in your essay. Type your essay in the box below. There is a 300 word limit.

Essay Questions: (* Required essay questions. **As required for specific scholarships.)
1: Why are you continuing your education?*
2: What are your professional/educational goals and how will you achieve them?
*
3: How have you shown leadership in contributing to your community?**
4: How have you demonstrated strong character such as responsibility, maturity, judgment and integrity?**
5: What are your financial needs and how will a scholarship benefit your educational goals?**
6: How has 4-H and/or FFA prepared you for the future?**
7: How have you demonstrated perseverance, high character and high effort to overcome a handicap?**

 


Additional Information:

Email Disclosure: All information submitted in this application is complete and accurate to the best of my knowledge. I understand that by signing this disclosure, I am giving my permission for the Merrick Foundation to use the information at its discretion for publicity purposes.

ELECTRONIC SIGNATURE: (Please type the last 5 digits of your social security no. to verify you have read and understand the above Email Disclosure:

For your records, it is recommend you print out the above application before hitting "Submit". 

Contact Information:

Merrick Foundation, Inc.
1532 17th Avenue, Suite B, Central City, NE 68826 Ph: 308.946.3707
General Information: merrick@hamilton.net

Copyright © 2002-2016 Merrick Foundation, Inc. Last modified: 12/14