Scholarship Application

Student Name(Required)

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Date of Birth

Parent or Guardian Name

First Last

Intended College Name

Intended College Address

Street Address City State / Province / Region ZIP / Postal Code

Intended College Phone

Intended College Major

Occupational Goal

Please list community, state, and high school activities in which you have participated:

Class Rank

Number in graduation class

Class Rank

A.C.T and/or S.A.T Score

Digital Signature

Please attach a photo, resume and cover letter describing why you should be chosen to be a recipient of a wester Nebraska bank scholarship.

Max. file size: 256 MB.

Application due by March 31, 2023. Paid at the end of the first completed semester to the attending college.