Medical Scholarship Application - DeKalb County Farm Bureau Foundation

Statement of Purpose

The DeKalb County Farm Bureau Foundation endeavors to recognize students for their academic performance while in medical school. The recognition is in the form of a scholarship to the student’s college of choice.

Eligibility

To apply for the Farm Bureau scholarship, a student must meet the following requirements:

Be an individual member or a dependent of a continual member in good standing of the DeKalb County Farm Bureau since Jan. 1, 2017.
Have their own membership if 22 years and older.
Be enrolled in an accredited medical school for the fall semester.

Scholarship Amount and Coverage

The $2,000 scholarship will be awarded for one year. Applicants may reapply. The award may be applied toward tuition and fees, housing, books and course supplies.

How to Apply

Complete and submit this application. College transcript should be uploaded with the application. It is recommended that you complete these application questions in a separate document then copy and paste into the online application. Please follow the scholarship application format. Failure to follow these guidelines may result in ineligibility.

The application must be completed in its entirety and transcript provided online to the DeKalb County Farm Bureau Foundation by the deadline.

Selection of Recipients

An impartial selection committee composed of Farm Bureau members selects the recipients soon after the application deadline. In evaluating the applications, the committee will ensure applicants first meet all of the eligibility requirements and then consider the content of the applications. The evaluation criteria will include academic performance, school activities and leadership experience, and involvement in non-school community activities. The awards will not be based on financial need.

Scholarship Conditions

Upon being awarded a scholarship, a recipient must:

Enroll as a full-time student for fall semester 2019.
Provide a statement attesting to the enrollment before payment is made.
Maintain a DeKalb County Farm Bureau membership.
Provide a photograph for Farm Bureau publicity.

Payment of Scholarship

The scholarship awards will be sent directly to the recipient’s school to be applied toward college costs. The payment will be sent in August.

Application Deadline

Applications must be submitted by Friday, June 14, 2019.

Direct inquiries to:

DeKalb County Farm Bureau
1350 W. Prairie Drive, Sycamore, IL 60178
815/756-6361
scholarships@dekalbfarmbureau.org

General Information
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
College Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Father/Stepfather/Guardian Name*
First Last
Father/Stepfather/Guardian Occupation*
Mother/Stepmother/Guardian Name*
First Last
Mother/Stepmother/Guardian Occupation*
Name DeKalb County Farm Bureau membership is listed under*
Academic Information
College attended in past*
College Attended GPA Years Attended Degree Earned
Year in school starting this fall*

(i.e. Undergraduate Senior, 1st Year Medical, 2nd Year Nursing)
Medical School Attending*
Date Accepted*
MM slash DD slash YYYY
Medical Field of Study*
Anticipated Medical Degree*
Graduation Date*
MM slash DD slash YYYY
Cost of Medical School Per Year*
Total Cost of College*
Upload Transcript:*
Max. file size: 256 MB.
Leadership Activities
List college, community, and related activities in which you have been involved while in college along with the year. Include any leadership positions held.
Scholarships/Grants
List the names and types of scholarships/grants you have received or are receiving. Do not include any loans or financial aid based on personal finances or grants that must be repaid.*
Student Statement - Part A
In the space provided, explain your educational and career objectives and long-term goals.*
Student Statement – Part B
In the space provided, explain why you should be awarded the Medical Scholarship.*
Student Essay
In the space provided, please answer the following: How can Farm Bureau engage students, like you, to share positive information about agriculture?*
Applicant Signature*
- I Agree
I hereby certify that the information on this application is true and accurate to the best of my knowledge as evidenced by this signature. I understand that all information contained on this application is subject to verification and that false information will lead to disqualification.
Date*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

College Attended	GPA	Years Attended	Degree Earned

General Information

Academic Information

Leadership Activities

Scholarships/Grants

Student Statement - Part A

Student Statement – Part B

Student Essay