Dakota Central Scholarship Application Reminder: to be eligible your parent(s) or guardian(s) must receive telephone, television or Internet service from Dakota Central. INSTRUCTIONS: 1) Please print or type (if you need additional space, please attach extra sheets) 2) Include all requested enclosures 3) Postmark application by February 23, 2007 Name of Applicant:_____________________________________________________________________ Address: ______________________________________________________________________________ City, State, Zip: _____________________________________________________________________ Name of Parent(s) or Guardian(s): _____________________________________________________ Telephone Number: ___________________________ E-mail: ________________________________ Social Security Number: _________________________ Date of Birth:______________________ High School: ________________________________ School Phone Number: ____________________ University or College you plan to attend: _____________________________________________ Intended Major (if known): _______________________________ Current GPA: _______________ Identify the activities in which you have been involved by circling the number of years you have participated in each. ______________________________________________________________________________________ Band 1 2 3 4| Cross Country 1 2 3 4| Football 1 2 3 4| Theater 1 2 3 4| Baseball 1 2 3 4| Debate 1 2 3 4| Foreign Lang. 1 2 3 4| Track 1 2 3 4| Basketball 1 2 3 4| Dance Team 1 2 3 4| Golf 1 2 3 4| Volleyball1 2 3 4| Cheerleader 1 2 3 4| FBLA 1 2 3 4| Newspaper 1 2 3 4| Wrestling 1 2 3 4| Choir 1 2 3 4| FFA 1 2 3 4| Speech 1 2 3 4| Yearbook 1 2 3 4| Other: 1 2 3 4| Other: 1 2 3 4| Other: 1 2 3 4| Other: 1 2 3 4| _______________________________________________________________________________________ High School Honors and Awards: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Have you had an opportunity to be employed or participate in any volunteer work and/or community activities during your high school years? Please list and describe. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Summary of your college plans: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Summary of your career plans: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Attach a short essay (300 words or less) telling us why you should be chosen to receive this scholarship. Checklist * Application Form. * Letter of recommendation from high school official/teacher. * Letter of recommendation from a community member (not related to applicant). * Short essay explaining why you should be chosen for this scholarship. * Copy of your high school transcript and photo. I DO HEREBY ACKNOWLEDGE THAT THE INFORMATION HEREIN PROVIDED BY ME IS TRUE AND CORRECT. ________________________________ ______________________________ Applicant Date Please return application to: Dakota Central Telecommunications Attn: Robin Anderson PO Box 299 Carrington, ND 58421 Or Dakota Central Telecommunications Attn: Robin Anderson 213 2nd Ave. NE Jamestown, ND 58401 Any inquiries should be directed to Robin Anderson at 701.652.6112 (Carrington), 701.952.1000 (Jamestown), 1.800.771.0974 (toll free). E-mail randerson@daktel.com.