Youth Grangers Education Scholarship Application

Name of Youth * Name of Parents (if applicant is a minor) Member Since *

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Street Address * City * State * Zip Code *

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School Attending * Major * Age * Date of Birth * Phone Number * Email Address *

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Please Submit a Current Photo Please tell us in paragraph form about your Grange experiences and your community service activities. Please write a paragraph letting us know about your educational goals and how you will use the Grange scholarship money. Optional: Attach a copy of your resume.

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If I am selected as a recipient of this scholarship, I give my consent to disclose my name and photo for use in press releases and other communications promoting the Grange Scholarship Program.

Applicant Signature *

Clear

Parent Signature (if applicant is a minor)

Clear

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