320 West Main, 3rd Floor Riverton, WY 82501

Scholarship Form

2020- 20121 Academic Year

Selected Scholarship Application

This scholarship is available for Fremont County residents only. This scholarship application form must be submitted to the BOCES office along with the class application.

Course I am applying for:

1. Personal Information

Full name of applicant

Nickname

Home telephone number

Email address

Present mailing address

City

State

Zip

Number of years lived in Fremont County

Citizenship

Date of birth

Last 4 digits of SS#

2. Tell us more about yourself. Check the appropriate boxes.

Have you ever been convicted of a felony?

Please Explain:

Have been or are currently on probation?

3. Race

Tribal Enrollment

4. Educational Level

Name of High School

Current Grade (if applicable)

5. Why do you want to take this course?

6. Have you ever taken a Fremont County BOCES class before?

If so, which ones?

Employment History

List jobs you have held in the last three years.

Year One

Employer

Dates

Hours per week

Position

Year Two

Employer

Dates

Hours per week

Position

Year Three

Employer

Dates

Hours per week

Position


I do state the above information is accurate to the best of my knowledge.

Signature of Applicant

If under 18 years of age: Parental Signature:

Date


NOTE: This scholarship application form must be submitted along with the course application. Filling out the scholarship form does not guarantee that you receive the scholarship.