NASMDA Youth Scholarship Application

NASMDA offers a $500 scholarship to graduating high school seniors.  The scholarship will be sent to the educational institution of your choice in your name.  You must be a member of the NASMDA youth in good standing to be considered.  Please fill out all the information completely either typed or in black ink.  In addition to the forms you need a letter of reference from a current NASMDA member (other than a family member) with their NASMDA number included.  Also Please include a 250-word essay on “How the Mule Industry Has Influenced Me”.

Awards can only be made to applicants who are NASMDA Youth members in good standing.

To be considered for these awards, applicants must complete the form as instructed and attach a copy of their high school transcript and senior class schedule.

Completed materials must be received by May 1st of the current year at NASMDA Scholarship, PO Box 207, Griswold, IA 51535.

1. Legal Name ________________________________________________________________
 

Last                             First                             Middle
2. Social Security Number ____________________________________
                                               
3. Home Address ________________________________________________________________
 

Address                             City                                  State/Zip Code

Phone

  (       ) 
   
4. High School ________________________________________________________________
 

Name                                 City                                  State/Zip Code

Phone

  (       ) 
   
5. College Choice ________________________________________________________________
  Name
  ________________________________________________________________
 

Address                             City                                  State/Zip Code
   
   

6. Must Be Signed By Applicant

  By checking this box and signing below, I agree that relevant information may be released to the news media.

  Further, by checking this box and signing below, I confirm the accuracy of the enclosed information and understand that any false or misleading statements may invalidate my application.

 

Signature: ______________________________________________  Date: ________________

7. Class Ranking and Test Scores:  The following information must be completed by a Principal or Counselor.

Cumulative unweighted GPA_____ (A=4.0)  
ACT composite score_________ Date tested___________  
SAT Verbal ______Math ______ Combined________ Date tested______________
Size of graduating class________ Rank in class______  
Graduation date______________    
ACT high school code [    ][    ][    ]-[    ] [    ][    ]

Please check all those for which student has qualified (Must send verification):

National Merit Semi-finalist National Achievement Semi-finalist
National Merit Commended National Achievement Commended

 
Principal or Counselor’s signature: ____________________________________ _____________
Must be completed by Principal or Counselor. Date

Please print name: _____________________________________________

  

Leadership, Honors, Activities
Identify and describe briefly in the appropriate spaces below your leadership responsibilities, honors and activities.  Information must be typed or printed in black ink.  Attached resumes will NOT be considered. Use only space provided.

Leadership             Elected positions (e.g. student council, class officer, clubs, etc.)
Organization 136

 

 

 

 

 

 

 

 Position Held 176 Describe Responsibilities 224 Grade 9,10,11,12
 
Honors                                     Academic, Leadership, All-State, Contest
Title and Award Description

 

 

 

 

 

 Grade 9,10,11,12
 

Activities              Special interest groups, fine arts, athletics, and community service
Name

 

 

 

 

 

 

 

 Describe Responsibilities/Involvement Grade 9,10,11,12
 
Other
 

 

 

 

 

 

 

 Grade 9,10,11,12

Completed materials must be received by May 1st of the current year at
NASMDA Scholarship, PO Box 207, Griswold, IA 51535.