High School Senior Scholarship Application

High School Senior Application for Scholarship Assistance from the Merrick Foundation, Inc.
Senior scholarships are available to graduating seniors who reside in Merrick County or attend a high school 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 ....*All fields required.

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 will you graduate?
2) School you plan to attend during 2017-2018:
3) Address of school:
    Is this a 4-year college?
    Is this a 2-year vocational / technical college?
4) College/Department enrolled in (i.e. teaching, business, arts & sciences):
   
5) What is your major?   minor?
6) Has your application for enrollment been accepted? Yes  No
7) 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
Merrick Foundation Industrious Student Warren & Virginia Marsh Memorial*
Merrick Foundation Founders William L. and Velma R. McLean*
Central City Scale Ralph Stanley and Ella Halstead 
      Severance Memorial*
Bonnie Kohl Memorial William and Emma Steffen Nurses*
Robert and Lillian Krug Memorial Austin and Cleo Vanderford*
Vernie L. Lock Leanne Zmek Memorial*
Elwin & Lucille Ferris*
Leonard and Doris Aerni Memoral

Albert & Dorothy Emgarten Memorial

J. Oren Hoback
Donald Nouzosky Memorial* Merrick County Pork Producers*
Dylan Van Pelt Memorial James & Marilyn Heins*
Wayne & Mildred Hilder Elton & Nancy Erickson
Lindner - Van Pelt Heritage Derek Aspedon Memorial*
Russ Russell*     
 
WESTERN MERRICK COUNTY AREA
Ray & Mildred Miller Memorial Benjamin Thomas Lindner Memorial
 
AURORA
Dylan Van Pelt Memorial  
 

CENTRAL CITY 

Karen and Dannielle Bannister Memorial Benjamin Thomas Lindner Memorial
Charles and Doris Benner Memorial Charles and Ann Kuhlman Memorial
Ervin and Bonnie Blauhorn* Ernest and Peggy Nabity Memorial
Donald R. Sampson* Edna I. Widman Memorial*
Myrtle and Jim Clarke*  


 

CENTURA
Gary Monter Memorial  
 
CHAPMAN
Alice Klingenberg Memorial Charles and Ann Kuhlman Memorial


CLARKS

Myrtle and Jim Clarke* Ethel Sweet Memorial*
Charles & Ann Kuhlman Memorial  
ELWOOD
Gary Monter Memorial
 
 
HIGH PLAINS
Karen and Dannielle Bannister Memorial  


NEBRASKA CHRISTIAN 

Myrtle and Jim Clarke* Charles and Ann Kuhlman Memorial
   


PALMER 

Ervin and Bonnie Blauhorn* Mary Chochon Memorial
Benjamin Thomas Lindner Memorial Ernest and Peggy Nabity Memorial
Gary Monter Memorial Clinton M. Wegner*
Richard "Dick" Chochon Memorial Henry "Bud" Santin Memorial


SILVER CREEK 

Les Johnson Memorial Gregory Rinkol Memorial*
Emil & Dorothy Czarnick Silver Creek Alumni
   


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.)

High School Activities: 

Academics:

     Mark Grade(s) of Participation

Academic Competition 9th 10th 11th 12th
Art Club 9th 10th 11th 12th
Business Professionals of America/FBLA 9th 10th 11th 12th
Class Officer 9th 10th 11th 12th
Future Farmers of America 9th 10th 11th 12th
Newspaper 9th 10th 11th 12th
National Honor Society 9th 10th 11th 12th
Student Council 9th 10th 11th 12th
Yearbook 9th 10th 11th 12th

Other Academic Activities Not Listed:
9th 10th 11th 12th
9th 10th 11th 12th
9th 10th 11th 12th
9th 10th 11th 12th

Academic Honors and Awards:



Athletics:

   Mark Grade(s) of Participation

Basketball 9th 10th 11th 12th
Cheerleader 9th 10th 11th 12th
Cross Country 9th 10th 11th 12th
Dance Team 9th 10th 11th 12th
Football 9th 10th 11th 12th
Golf 9th 10th 11th 12th
Soccer 9th 10th 11th 12th
Softball 9th 10th 11th 12th
Track 9th 10th 11th 12th
Wrestling 9th 10th 11th 12th
Volleyball 9th 10th 11th 12th

Other Athletic Activities Not Listed:
9th 10th 11th 12th
9th 10th 11th 12th
9th 10th 11th 12th
9th 10th 11th 12th

Athletic Honors and Awards:


Drama/Music/Speech:

   Mark Grade(s) of Participation

Band (Pep, Jazz, Concert) 9th 10th 11th 12th
Choir 9th 10th 11th 12th
Class Plays 9th 10th 11th 12th
Drama Club 9th 10th 11th 12th
School Musical 9th 10th 11th 12th
Speech Team 9th 10th 11th 12th
Swing Choir 9th 10th 11th 12th

Other School Drama/Music/Speech Activities Not Listed:
9th 10th 11th 12th
9th 10th 11th 12th
9th 10th 11th 12th
9th 10th 11th 12th

Drama/Music/Speech Honors and Awards:


Church/Religious and Community Activities: 


Church/Religious:

                                                            Mark Grade(s) of Participation
9th 10th 11th 12th
9th 10th 11th 12th
9th 10th 11th 12th
9th 10th 11th 12th

Additional information regarding your involvement in these activities:


Community and Volunteer Activities:

(ex. Summer Sports, Boy or Girl Scouts, Dance, Piano)

                      Mark Grade(s) of Participation

4-H 9th 10th 11th 12th
9th 10th 11th 12th
9th 10th 11th 12th
9th 10th 11th 12th

Additional information regarding your involvement in these activities:


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 © 2002-2015 Merrick Foundation, Inc. Last modified: 12/14