Annie Epting Scholarship - Chapin Chamber of Commerce and Welcome Center

Thank you for taking the time to apply for the Annie Epting Scholarship! To ensure we have all the information needed for evaluation, please complete this application in full.

Submissions must be completed by March 26th, 2024.

Applicant's Full Name

High School Name

Applicant's Complete Address:

Phone:

Email:

Name of College or University you plan to attend:

Have you formally applied?

YesNo

Were you accepted?

YesNo

Family/Household Information

Number of brothers and/or sisters living at home:

Age of each:

Number of siblings attending college:

Name(s) of College(s):

Extracurricular Activity Information

Please list any extracurricular activities you were involved in:

Please indicate your membership in any honorary societies or other organizations including any offices held in each:

Please list any community service activities you were involved in and include a brief description of each:

You may attach a document if needed for your extracurricular activity.

Applicant's Final Thoughts

Please write a brief paragraph explaining why you should be chosen as the recipient of this year's Annie Epting Scholarship.

You may attache a document if needed for your final thoughts.

Academics

GPA (weighted)

Rank:

Highest SAT/ACT:

School Counselor's Name to verify academics:

Please attach a letter of recommendation from a faculty member.

Please attach a letter of recommendation from a personal reference.

ASSIGNMENT OF RIGHTS & CONSENT TO PUBLISH SCHOLARSHIP INFORMATION

KNOW ALL PERSONS BY THESE PRESENTS:

That I,

do hereby give The Greater Chapin Chamber of Commerce full rights to publish my name, where I live (city and state only; actual street addresses and phone number WILL NOT be disclosed), my pertinent family information (financial information WILL NOT be disclosed), college I am attending, and any photographs that may be taken upon presentation of scholarship if I am chosen as the recipient.

I understand that by execution of this agreement, I am relinquishing my rights to any future compensation for reproduction, publication or use of the above information by The Greater Chapin Chamber of Commerce in its print or electronic correspondence, on its website or social media websites.

I understand that this Agreement in no way obligates The Greater Chapin Chamber of Commerce to publish or use the above-described information.

EXECUTED this date of

Applicant Signature:

Witness Signature:

The parties agree that this Agreement may be executed and delivered by electronic signatures and that the typed signatures appearing above are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.