Francis Grant Triebel
Memorial Scholarship Fund Application
(Student Must Attend University
of Illinois)
Name of Student _________________________ Social Security # _____-___-_____
Permanent Address __________________________ Telephone (____)___________
____________________________________________ Zip Code ________________
Name of Parents/Guardian_______________________________________________
Resides with__________________________________________________________
College______________________________________ Are You Accepted? _______
Are you an American citizen? ______yes ______no
High School ________________________________ Telephone (____)___________
High School Address ___________________________________________________
Street City State Zip
Name of Counselor_____________________________________________________
Year of Graduation__________ Is your high school accredited? _____yes _____no
Class size __________ Class rank __________ GPA __________
If You Are A
College Student Applying For Renewal Please Answer The Following Questions
Year In College __________ Total Credit Hours__________ GPA/Scale__________
Will You Be Returning To U Of
Course of Study________________________________________________________
Advisor’s Name______________________________ Telephone (____)___________
Advisor Address _______________________________________________________
Street City State Zip
Have You Been Convicted Of A Misdemeanor Or A Felony? ______Yes ______No
Please Attach To This Application The
Following:
1.
Completed Financial Form
2.
An Official Transcript Of Your High School Grades
(College Students Attach An Official Transcript Of Your College Grades)
3.
A Brief Summary Of Your Educational Objectives
4.
Two Letters Of Personal Reference/Recommendation
(Not From A Relative)
5.
A Personal Biography (300-400 Words)
6.
List Of Extra-Curricular Activities, Honors,
Accomplishments
Return This Application To:
Audrey Johnson Telephone: (815) 282-3537