BUCK FOUNDATION UPPERCLASSMEN
SCHOLARSHIP APPLICATION
SIGNATURE PAGE
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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
Rogers, AR 72756
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