Scholarships - Ann Smeltzer Charitable Trust

Section A

School Year you are enrolling*

College/School to which you are applying*

Semester you are enrolling*

Fall
Spring
Summer

Section B

Have you previously received a scholarship from the Smeltzer Trust?*

Yes
No

If yes, which semester and year?

Are you applying for other scholarships?

Yes
No

If yes, please list from whom and the amount(s) in the space below

Section C

Full Legal Name*

First Middle Last

Birthdate*

Phone*

Permanent Address*

Street Address City State ZIP Code

Local Address

Street Address City State ZIP Code

Email*

Section D

College Major*

The scholarship includes areas of study listed below. Please check the area(s) in which you are interested.*

Please state your future planes in the space below*

Please list school, community, volunteer, and church activities in which you have participated. Include any offices and/or leadership roles you have held. You may also attach a list or resume.*

Resume

Max. file size: 8 MB.

Section E (to be completed by college freshmen applicants only)

High School Name

High School Graduation Date

High School Address

City State ZIP Code

Class Rank

Number of Students in Class

Current Cumulative GPA in hundredths (A=4.00, B=3.00, C=2.00, D=1.00)

Composite ACT, SAT or ASSET score

Please attach an official copy of your high school transcript as well as an official copy of your college transcript.

Max. file size: 8 MB.

Section F (to be completed by all other applicants)

Name of College (if currently enrolled)

Projected Graduation Date/Graduation Date

College Address

Street Address City State ZIP Code

Please attach an official copy of your college transcript(s).

Max. file size: 8 MB.

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

Signature*

Please note that a signature is required for this application to be processed.

Please mail a copy of this application and all pertinent paperwork to:
Ann Smeltzer Charitable Trust
c/o Scholarship Applications
PO Box 791
Fort Dodge, Iowa 50501-4245