Complete the following application and mail to the address below.

Name: ____________________________________ Phone: _____________________________________

Address: ___________________________________ E-mail:_____________________________________

___________________________________________ Fax: ______________________________________

Parent’s Names: (Father )_________________________ (Mother)________________________________ 

High School: _____________________________________ Graduation Date: __________ GPA: _______

High School Activities:___________________________________________________________________

______________________________________________________________________________________

College Attending: ____________________________ Date Accepted: ____________________________

Address:____________________________________ Major: ____________________________________

___________________________________________ Credits Earned: _____________________________

Phone: _____________________________________ GPA (if applicable): __________________________

Activities: _______________________________________________________________________________

________________________________________________________________________________________

Honor Awards (HS, College, Civic org.): _______________________________________________________

Other Scholarships Received: ____________________________________ Amount: $__________________

Current Volunteer Activities: ________________________________________________________________

Name of local paper: _____________________________ May we notify them of award? yes_____ no_____

References: 1. Name: _________________________ 2. Name: ____________________________________

Address: __________________________                   Address: ____________________________________

__________________________________                                 ____________________________________

Phone: __________________________                      Phone: _____________________________________

On a Separate sheet, answer the following questions.

What are your career goals?

Statement of Financial need?

Why should you receive this scholarship?

Background in agriculture incl. crops grown

Signature: __________________________________ Date: __________________________________

Mail by June 1st to: MGPUB, 53 Slama Road, Edgewater MD 21037.  For more information, email Maryland Grain Producers, call 410-956-5771.