Name *

First Name

Last Name

Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you: *

Enrolled

Accepted but not yet enrolled

Planning to enroll

Scholarships you would like to be considered for: *

Baraibar Memorial Scholarship (Okoboji High School seniors)

Hamski Memorial Scholarship (Ottumwa High School Seniors)

Maher Memorial Scholarship (open to Iowa high school seniors in Fremont & Page counties.. *Preference given to those entering trade school)

Puente-Morales Memorial Scholarship (AGWSR High School Seniors)

Sesker Memorial Scholarship (Ogden High School Seniors)

Sissel Memorial Scholarship (Cedar County High School Seniors)

Broderick Memorial Scholarship (Valley or Cherokee High Schools)