NeFDA scholarship application

NEBRASKA FUNERAL DIRECTORS ASSOCIATION WALLACE S. & WILMA K. LAUGHLIN FOUNDATION TRUST AND/OR DOROTHY E. SWANSON CHARITABLE TRUST SCHOLARSHIP

Legal Name:

Last, First, Middle

Gender:

Usually called:

Former last name(s), if any:

Date of Birth:

Date

Permanent Home Address:

City, State, Zip:

Phone Number:

E-mail Address:

Social Security Number:

Family

Father's Full Name:

Is he living?

Father's Home Address:

Occupation: (Describe briefly)

Mother's Full Name:

Is she living?

Mother's Home Address:

Occupation: (Describe briefly)

Brothers & Sisters (and ages):

Academic Honors

Briefly describe any scholastic distinctions or honors you have been awarded in high school and/or college.

EXTRACURRICULAR AND PERSONAL ACTIVITES

Please list your principal extracurricular, community, and family activities and hobbies in order of their interest to you. For example, musical instrument played, varsity letters earned, etc.

Have you completed all college credit requirements in subjects and credit hours required by the State of Nebraska as pre-mortuary academic requirements?

Yes. A statement from the Dept. of Regulations & Licensure Credentialing, PO Box 94986, Lincoln, NE 68509, verifying subjects and hours completed must accompany this application. Download letter template on website to request DHHS review.No. List those areas not yet completed, give completion date, and attach to the application. When completed, a statement from the Dept. of Regulations & Licensure Credentialing verifying subjects and hours must be submitted to the Nebraska FDA/Laughlin/Swanson Trusts. All requirements must be completed prior to entering mortuary college to be eligible for either scholarship.

Work Expereince

Please list the last three jobs (including summer jobs) you have held. Specific nature of work, employer, approx. dates, and approx. number of hours worked each week:

Personal Statement

It is our aim to get to know you as well as possible during this application. With this in mind, please describe in detail some special interest, experience or achievement or anything else you would like us to know about you. Describe why you feel you should be considered for the Laughlin or Swanson Trust Scholarship.

I have received another scholarship for mortuary school:

YesNo

I will be attending (school):

Date Term Begins

Date

Signature

Date

The following member of the Nebraska Funeral Directors Association endorses my application. Statement of recommendation of this member is either included with this application or will be sent separately.

ATTACH TO APPLICATION: (1) Transcript with class rank and grade point average for high school and college. (2) Statement from Dept. of Regulations & Licensure showing semester hours earned. (3) Statement of recommendations from a Nebraska FDA member.

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