BUCK FOUNDATION UPPERCLASSMEN
SCHOLARSHIP APPLICATION
SIGNATURE PAGE

 

TO PRINT THIS FORM, CLICK YOUR BROWSER "PRINT" BUTTON.   AFTER PRINTING HAS STARTED, CLICK YOUR BROWSER "BACK" BUTTON  TO SELECT YOUR NEXT FORM TO PRINT.

 

YOU MUST PRINT THIS FORM OUT IN ORDER TO SIGN IT AND MAIL IT TO THE BUCK FOUNDATION.  DO NOT TRY TO FILL IT OUT AND SUBMIT IT ONLINE.

 

Please read the following statements carefully.  Your signature indicates that you both have read and understand the following statements:

 

Scholarships require criteria or conditions to be met by the recipient.  Changing your major or college may result in the termination of your scholarship.  If you are awarded a Buck Family Foundation Scholarship, contact Jan Buck (479-925-2597) before making any changes.  You should understand that these scholarships are to be used for your next two semesters of college and that you are expected to remain in school for at least that long.  Should you decide to leave college without completing a semester, you could be asked to repay any scholarship money used in the incomplete semester.

 

Certification – I certify that, to the best of my knowledge, the information on this application is accurate and complete and that the signatures below are valid.  I understand that should either signature be found invalid, my application will be removed from consideration for the local scholarship.  I also certify that I understand that the information contained in this application will be made available to the donors, including all information on my transcript.

 

Student Signature:  _________________________________________               Date:  __________________

 

Sign this statement, attach a copy of your most recent college transcript SHOWING ALL CLASSES TAKEN THROUGH FALL 2011 (if you e-mailed the college transcript you need not attach a copy of it to the signature page), and also attach a copy of your high school transcript including ACT or SAT scores.

 

Cut out the label below and paste it to your envelope for mailing or shipping.
Or you may prepare your own label with this information.

___________________________________________________________________________________________

Jan Buck, Coordinator

Tele:  479-925-2597

The Buck Foundation

15249 Dutchman’s Drive

Rogers, AR  72756

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