Note: All transcripts and letters of recommendation must accompany this application.

NAME IN FULL________________________________________________________
FirstMiddle InitialLast

Street No.County

______________________________________________________________________
CityStateZipHow long?Telephone

STUDENT ADDRESS____________________________________________________
(if enrolled in college)Street No.How long will you be there?

______________________________________________________________________
CityStateZipTelephone

DATE OF BIRTH__________ BIRTHPLACE____________________________________
Month / Day / YearCityStateMale/Female?

Social Security #_____________________ If married, spouse's name___________________

Father's name_________________________ Mother's name_________________________

Father's Occupation_____________________ Mother's Occupation____________________

Are you, or your parents, county Farm Bureau members?YesNo

If yes, give membership number_______________________________________________

How did you find out about this scholarship? _______________________________________

List high school, junior college and college(s) attended (including your present school). Do not include single course or class studies, i.e. night school.

List your work experience during the past four years. Indicate dates of employment, approximate number of hours worked each week, and total amount earned at each job.

List all extracurricular activities (school and community) you participated in during the past four years without pay, i.e. Red Cross, church, work, sports, volunteer work. Attach additional page, if necessary.

Please indicate any unusual family or personal circumstances you feel warrant special attention

_____________________________________________________________________

Are you willing to report on your progress and provide an accounting of your income and expenses at any time?
YesNo

What college or university do you plan to attend?_________________________________

City _______________________When?__________________Current GPA___________

Major course of study _________________________________________________________

For what occupation are you preparing? ____________________________________________

My college class standing in September will be:
FreshmanSophomoreJuniorSeniorCollege Graduate

Will you live at home or on campus?HomeCampus

Expected date of graduation_____________________________

Will you work while attending college?YesNo

Please list the amount and names of any grants or scholarships that you have been awarded for the

coming school year ______________________________________________________

_____________________________________________________________________

Have you received a California Farm Bureau scholarship in the past?YesNo

If yes, what year(s)______________

List dependent members of immediate family:

List brothers or sisters in college:

LETTERS OF RECOMMENDATION: Applicant must submit two (2) current letters of recommendation (refer to instructions for guidelines). The persons writing letters of recommendation (relatives excluded) are:

Name ____________________________________ Occupation __________________

Name ____________________________________ Occupation __________________

APPLICANT ESSAY: Describe the most important educational or personal experience that has led you to pursue a university education. Include reasons for your choice of major subject and your present plans for the future. Please type or write legibly and be brief (use additional paper, if necessary).

Signature_______________________________________________ Date____________________