Testing the form - DeKalb County Farm Bureau Foundation

General Information

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

High School*

Father/Stepfather/Guardian Name*

Father/Stepfather/Guardian Occupation*

Mother/Stepmother/Guardian Name*

Mother/Stepmother/Guardian Occupation*

College you will be attending*

Major*

Name DeKalb County Farm Bureau membership is listed under

School Activities

List Major School Activities*

List major school-related activities (office held, awards, competitions, level of participation, and year). One entry per line.

Community Activities

List all Community Activities*

List involvement and achievements in major non-school and community activities. Do not duplicate activities listed above.

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 selected to receive a Farm Bureau scholarship.*

Student Essay

In the space provided, please answer the following question: How can Farm Bureau engage students, like you, to share positive information about agriculture?*

Work Experience

List your work experience. Please provide the Year, Name of Employer, and Type of Employment.*

Certification Statement

I hereby certify that the information on this application is true and accurate to the best of my knowledge as evidenced by these signatures. I understand that all information contained on this application is subject to verification and that false information will lead to disqualification.

Student Agreement*

I agree to the above certification statement.

Parent Agreement*

I (the parent) agree to the above certification statement.

Date*

Phone

This field is for validation purposes and should be left unchanged.