New York Rabbit & Cavy Breeders Association
Youth Scholarship Application
High School Data Form

As an applicant for the NYSRCBA Youth Scholarship, I hereby request that you, as my High School Designated official, fill out this form and mail it in accordance with directions given below.

Signature of applicant:__________________________________________Date:_______________

1. Name of applicant (print):_________________________________________________________

2. Address of applicant: (Street)________________________________________________________

(City / State / Zip) ___________________________________________________________________

3. Name of High School: ____________________________________________________________

4. Address of High School: (Street)_____________________________________________________

(City / State / Zip) ___________________________________________________________________

5. In what manner do you know this applicant? ___________________________________________

________________________________________________________________________________

 6. Has the applicant shown serious shortcomings of any kind including disciplinary, attendance and/or social problems, scholastically or otherwise? Yes ______ No ______

If yes, please explain_______________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

7. To be eligible for the NYR&CBA Youth Scholarship, this applicant must have a GPA high enough to be accepted by an accredited college/university or vocational school. Is this applicant eligible under this provision? Yes_____ No _____GPA__________

Signature of person completing form____________________________________________________
Print or type name______________________________________________ Date_______________

Please mail complete form to: Tammy Cook 578 Fulton Rd Lisbon NY 13658



Application for Scholarship
New York State Rabbit & Cavy Breeders Association
Tammy Cook 578 Fulton Rd Lisbon NY 13658

Type or print in ink all information requested. Form must be submitted to the above address by SEPT. 15th.

I hereby apply for a scholarship under the NYR&CBA Youth Scholarship Program and submit the following information:

1. Name:______________________________________________________________________
Last / First / Middle
2. Home Address of applicant (street)___________________________________________________

City / State / Zip ____________________________________________________________________

3. Birth date (Month / Day / Year) ____ ____ ____ 4. Member of NYR&CBA club since ____________

5. Please describe in your own words, your work activities during your High School years, either for your family at home or for outside employers.










6. Specify what part you played in organized in-school activities or out-of-school activities such as class or other school offices held, band, orchestra, athletics, drama, oratory, school publications, honor society, Boy/Girl Scouts, church organizations, etc. Did you receive special recognition?

Activity Position Hrs spent per week Award












Application for Scholarship
New York State Rabbit & Cavy Breeders Association
High School Data Form

**** Answer the following questions completely. Use a separate sheet of paper if necessary. ****

A. Have you held an office or been on a committee in a Rabbit/Cavy organization in the past four years? Yes_____ No_____. If yes, please list:




B. What benefits and knowledge have you acquired as a result of your NYR&CBA affiliated club membership?



C. What have you done to encourage others to join an NYR&CBA affiliated club?




D. How have you been promoting the Rabbit/Cavy industry (helped teach others new skills or increase their knowledge of rabbits/cavies) in the past year?




E. Write a paragraph on "Why I want to continue my education." Include educational objectives, field of endeavor, and the reason(s) you have decided on these choices.





Certification
I have personally delivered the"High School Data Form" to my High School Principal or designated official. I certify that to the best of my knowledge, all statements contained in this application are true and correct, that I have read the guidelines and rules issued by the NYR&CBA, and that I believe myself eligible for a scholarship under the guidelines and rules contained herein.

_______________________________________________________ _____________________
Signature of applicant / Date