Arkansas Air & Space Forces Association
Arkansas State Association
David D. Terry Chapter # 253
Jacksonville, AR
Lewis E. Lyle
Chapter # 270
Hot Springs, AR
Arkansas Air & Space Forces Association
1. Name: SSAN:
2. Date of Birth: Home Phone:
3. Home Address:
4.
Father's Name:
5. Mother's Name:
6. High School(s) attended Grades Attended
7.
High School Graduation Date: Class Standing:
High School Grade Point: ACT/ACT Score:
9. Employment: (List any employment including summer jobs, baby sitting, after school jobs.
Also include any volunteer work).
(if already in college use current information)
Employer/Address Dates Hours/Week
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10. Extracurricular Activities: (List the School/civil organization in which you participated, but did not hold an elected or appointed office).
Freshman Year (High School or College) (circle one)
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Sophomore Year (High School or College) (circle one)
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Junior Year
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Senior Year
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11. Extracurricular Activities: (List the School/civil organization in which you held an elected or appointed office).
Freshman Year (High School or College) (circle one)
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Sophomore Year(High School or College) (circle one)
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______________________________________________________________________ ______________________________________________________________________ Junior Year
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Senior Year
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12. Honors or Awards: (List any honors or awards received).
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13. List the college, fine arts institute or vocational/technical school to which you have applied for admission or to which you plan to apply.
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14. List all scholarships that you have been awarded. (These will have no bearing on your selection unless you have been awarded a 4 year scholarship to a service academy).
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15. If you are already attending college fill in the name of college(s) attended(ing):
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15a Pursuing a degree in:
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Additional information required:
1. High School or College transcript(s) that includes the last semester attended.
2. Two referrals (1 of which must be a teacher from your high school or college)
3. A letter (typed) stating what this scholarship will mean to you.
16. Certification:
I understand the eligibility requirements for selection and awarding of this scholarship. I also certify that all of the information on this application is correct.
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Applicant Date
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Parent Date
MAIL APPLICATION TO:
SCHOLARSHIP COMMITTEE
DAVID D. TERRY Jr. CHAPTER, #253
AIR & SPACE FORCE ASSOCIATION
501 BREWER
JACKSONVILLE, AR 72076
KEHLER SCHOLARSHIP APPLICATION