Kauai County Farm Bureau - supporting Kauai's farmers

HTFFA Scholarship Application

First Name: Last Name:

Social Security #:

Mailing Address:

City: State: Zip:

Telephone: Email:

Date of Birth: Place of Birth:

Current School: GPA:

Father / Guardian: Occupation:

Mother / Guardian: Occupation:

Total Family Gross Income: (Include all members of the family) for the most recent tax year:

Why do you feel that you deserve this Scholarship?

Please describe your involvement in the following areas, including any awards, special acknowledgments, etc.: academic, community service, sports, clubs, and organizations, hobbies/special interests, job/work experience:

CERTIFICATION:
I do hereby certify that the information provided in this application was complied and written solely by the undersigned and that the data is true and correct as of this date.
I consent to the review and release of this application to the appropriate persons in HTFFA and understand that HTFFA requires my Social Security Number for its records.
I agree and grant permission to HTFFA for the use of my name and other information for the purpose of promotion, advertising, recognition and/or news releases including publications, without promise of favor or payment. Documents received will be used solely by HTFFA.

Reminder: to complete your application, you must submit three (3) letters of recommendation and a current official transcript to HTFFA, PO Box 2015, Kapaa, HI 96746.

First Name:		Last Name:
Social Security #:
Mailing Address:
City:	State: Zip:
Telephone:		Email:
Date of Birth:		Place of Birth:
Current School:		GPA:
Father / Guardian:		Occupation:
Mother / Guardian:		Occupation:
Total Family Gross Income: (Include all members of the family) for the most recent tax year:
Why do you feel that you deserve this Scholarship? Please describe your involvement in the following areas, including any awards, special acknowledgments, etc.: academic, community service, sports, clubs, and organizations, hobbies/special interests, job/work experience: CERTIFICATION: I do hereby certify that the information provided in this application was complied and written solely by the undersigned and that the data is true and correct as of this date. I consent to the review and release of this application to the appropriate persons in HTFFA and understand that HTFFA requires my Social Security Number for its records. I agree and grant permission to HTFFA for the use of my name and other information for the purpose of promotion, advertising, recognition and/or news releases including publications, without promise of favor or payment. Documents received will be used solely by HTFFA. Reminder: to complete your application, you must submit three (3) letters of recommendation and a current official transcript to HTFFA, PO Box 2015, Kapaa, HI 96746.