Application - template : Scholarship Applications : Scholarships : Receive : North Dakota Community Foundation

Dick & Dean Bultema Memorial Scholarship

Name of Student

Email Address

Please use permanent email address, not school assigned email.

Phone Number

Mailing Address

City, State, Zip

Parent/Guardian (1)

Email Address

Phone Number

Mailing Address

City, State, Zip

Parent/Guardian (2):

Email Address

Phone Number

Mailing Address

City, State, Zip

High School

Phone Number

Mailing Address

City, State, Zip

Principal Name

GPA

Post-secondary school planning to attend:

If undecided, please list top 3 options.

Major

If undecided, please enter undecided.

ACT Scores (American College Testing Program)

Transcript

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Career goals after post-secondary education:

Activities & special interests (work experience, honors, and other activities):

Other than financial need why do you think you should receive this scholarship:

Statement of financial need: Many scholarship awards are based on financial need. The committee choosing the recipient must rely on the information in this application in order to make a wise choice. Please include any pertinent information to help the committee make a decision, such as: amount of any financial aid you may receive from your family, government student loans, number of siblings in college, special financial situation which may affect your ability to pay for college, government grants you may be receiving and other scholarships you may have already been awarded.

Family Support:

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Number of Siblings Attending College:

Government Grants:

Student Loans

Other Loans:

Scholarships:

Other Financial Information:

This form must be completed with transcript attached to be considered for scholarship.

Enter Full Name

Entering your name above will act as an electronic signature.

Application - template

Dick & Dean Bultema Memorial Scholarship

Headquarters

Larimore Office

Dickinson Office

Wahpeton Office