Vernon J. Pick Foundation Scholarship Application Form

Vernon J. Pick Foundation Scholarship Application
Application Deadline: March 15 of Year Applicant Will Enter College or University

Please complete all requested areas of form and print to submit to the foundation. Scholarship recipients will be notified by May 10 of the year of application.

Scholarships will be awarded in the amount $2,500 as a one-time award. Funds will be provided directly to the institution where the recipient has enrolled, and typically are sent in July of the year of enrollment.

All applicants must submit a current high school transcript and documentation of ACT and/or SAT test scores. Letters of recommendation may be included, or may be directly submitted to the foundation.

Eligible applicants are high school seniors from the following Minnesota counties: Kittson, Roseau, Lake of the woods, Koochiching, Marshall, Beltrami, Itasca, Pennington, Red Lake, Clearwater, and Polk.

Applicants must be planning college study in STEM fields including science, mathematics, engineering, medicine, medical technology, nursing, biology, chemistry, physics, animal science, forestry and wildlife management. This is not a complete list and is intended only as a guide.

Minimum qualification requirements:

1. GPA of 3.5 or greater.

2. ACT test score of 25 or SAT score of 1200 or greater.

Applications are to be mailed to:

Vernon J. Pick Foundation

Scholarship Coordinator

8090 Esther Lane NE

Bemidji, MN 56601

If selected, you may be asked for additional documentation to support the data you provide.

I. Personal Data:
Full Name

First NameMiddle InitialLast Name
Birthdate:

MonthDayYear
Date
Phone No. :

Area CodePhone Number
E-mail :
Home Address :

Street Address

Street Address Line 2

CityState

Zip Code
Name of the college or university you plan to attend:
Address of the college or university you plan to attend:
Anticipated major area of study:
II. High School Information:
High school(s) attended:
High school address(es):
Year of high school graduation or GED:
Most recent cumulative GPA:
Size of high school graduating class:
Current class rank:
High school extracurricular activities and years of participation:
Any additional volunteer or other activities:
List any honors, prizes, offices held, or special recognitions received during high school. Include dates.
III. ACT or SAT Information:
Score(s) to be included:
Score(s) received:
Official documentation of reported score(s) must be included with application.
IV. Letters of Recommendation:
Name and phone number of 2 persons providing letters of recommendation:
Are letters included with this application? (Note: currently digital submissions are not possible.)
V. Work Experience :
List employer, position/duties, dates worked, and hours worked weekly:
VI. Essays
Your essays should be limited to 750 words each. Essays may be attached separately if desired.
1. How did you develop an interest in your chosen field of study?

0/750
2. Discuss your approach to problem-solving. This may address your approach in school and/or other settings.

0/750

VII. Applicant's Signature
Please indicate the date of your signature, print your form using the button below, sign, and submit to the address listed at the beginning of this form. Be sure to attach requested documentation including high school transcript, letters of reference, and documentation of test scores.

All information furnished on this application for the Vernon J. Pick Foundation Scholarship is true and correct to the best of my knowledge and belief. I understand that all information furnished to the foundation will be kept confidential.
Date

MonthDayYear
Date
Signature - sign by hand after printing form
Should be Empty:

Vernon J. Pick Foundation Scholarship Application

I. Personal Data:

II. High School Information:

III. ACT or SAT Information:

IV. Letters of Recommendation:

V. Work Experience :

VI. Essays

VII. Applicant's Signature