Cotton Scholarship - Student Form

Student Entry Form

Student Full Name*

Student Email Address*

Phone Number*

Address

Address*

Address 2

City/Town*

State/Province*

ZIP/Postal Code*

Nominated by:*

Name of High School*

Year of Graduation*

Name of College*

City*

Year Level*

(Entering Freshman, Freshman, Sophomore, Junior, Senior or Graduate)

Major*

Anticipated Graduation Year*

Advisor Full Name*

Advisor Email Address*

Extracurricular School Activities*

Leadership Positions Held*

When did you work for your nominating cotton consultant?*

What type of work did you complete?*

After you graduate from college, what type of a career are you interested in? *

Why would you be a good candidate for the Cotton Industry Advancement Scholarship?*

Does your family farm?

Yes

What crops are grown and how many acres do you farm?

Are you considered a minor by state for federal law?

Yes

Applicant Signature*

Sign above

I certify that the information on this application is true and correct.*

I agree to the scholarship Rules and Regulations*