KANSAS SHERIFFS ASSOCIATION
Box 1853
Salina, KS 67402-1853

Scholarship Application
Personal
Date __________________________
Name ______________________________________ Date of Birth _______________ Age ______
Address ________________________________City _______________ Zip ________ Phone _____________________
Name of Current KSA Member _________________________ Relationship to Applicant_____________

Education
High School _____________________ City __________________Date Graduated _______ GPA _____
College _________________________ City ____________________ Date ________ GPA _____
Other Schools Attended/City/Date



Name/Address of Kansas College Planning to Attend
______________________________________________________________________
Major Planning to Pursue
_______________________________________________________________________
List any special abilities, interests, volunteer jobs, and hobbies:

List awards, honors, positions held in school organizations, activities and/or athletic endeavors, and any special recognitions received:
______________________________________________________________________________________________
______________________________________________________________________________________________
List chronologically your three most recent jobs, including summer and part-time:
________________________________________ From _____________ To _____________
________________________________________ From _____________ To _____________
________________________________________ From _____________ To _____________
Organization Memberships List any clubs, societies, or organizations in which you are or have been a member:






Why do you deserve this scholarship?





SUBMIT THE
FOLLOWING:		 1. One letter of recommendation from a KSA member.
2. A short, typed essay (at least 150 words) on why you intend to pursue your chosen career.
3. Two (2) recent photos.
4. The name and address of your home town newspaper.


Applicant Signature ______________________________________________________________

Application form may be copied. Pronto Print Salina, Inc.