2023 RICFBF Scholarship Application

1
Read and follow the instructions carefully prior to submitting your application. (Scholarship Guidelines). All winners will be notified on or before the 1st of May 2023.

If selected, you may be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
2
Are you a current Farm Bureau member or a dependent of a Farm Bureau member?* This field is required.
YESNO
3
Parents' or Your Farm Bureau Membership Number* This field is required.
4
Full Name* This field is required.
First Name
Last Name
5
Birthdate:* This field is required.
Month
Day
Year
6
Mobile No. :* This field is required.
Area Code
Phone Number
7
E-mail :* This field is required.Please indicate correct E-mail as your confirmation for scholarship eligibility will be sent to this address.
Where the confirmation will be send to
8
Home Address :* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
9
County of Residence:* This field is required.
Rock Island
Mercer
Henry
Whiteside
Other
10
Parents or Guardians Full Name:* This field is required.
11
Parent Email
example@example.com
12
Are you currently a high school senior?
YESNO
13
High School Graduation Date* This field is required.
Year
14
High School Attended (scroll down for complete list):* This field is required.
Rockridge
Riverdale
Rock Island
Moline
United Township
Alleman
Sherrard
Orion
Other
15
High School Transcripts* This field is required.Please include your high school transcripts.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
16
Cumulative High School GPA:* This field is required.If on a 5.0 scale, it must be converted to 4.0 scale.
17
Class Rank:
18
Class Size:
19
High School activities, community activities, volunteer work, honors, offices held:* This field is required.
20
ACT score
21
SAT (EBRW) score
22
SAT (Math) score
23
I will be attending the following school in the Fall of 2023:* This field is required.
24
Status as of Fall 2023* This field is required.
College Freshman
College Sophomore
College Junior
College Senior
25
University/College Address (Financial Aid Office)* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
26
Degree of Study Letter* This field is required.Please attach a letter of acceptance from your College/University. If you are studying for a two year degree, a letter from a your academic adviser is acceptable.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
27
Major Area of Study:* This field is required.
AGRICULTURE & NATURAL RESOURCES CONSERVATION
ARCHITECTURE
AREA, ETHNIC, & MULTIDISCIPLINARY STUDIES
ARTS: VISUAL & PERFORMING
BUSINESS
COMMUNICATIONS
COMMUNITY, FAMILY, & PERSONAL SERVICES
COMPUTER SCIENCE & MATHEMATICS
EDUCATION
ENGINEERING
ENGINEERING TECHNOLOGY & DRAFTING
ENGLISH & FOREIGN LANGUAGES
HEALTH ADMINISTRATION & ASSISTING
HEALTH SCIENCES & TECHNOLOGIES
PHILOSOPHY, RELIGION, & THEOLOGY
REPAIR, PRODUCTION, & CONSTRUCTION
SCIENCES: BIOLOGICAL & PHYSICAL
SOCIAL SCIENCES & LAW
UNDECIDED/OTHER
Please indicate your major area of study
28
Agriculture & Natural Resources Conservation
Agriculture, General
Agribusiness Operations
Agricultural Business & Management
Agricultural Economics
Agricultural Mechanization
Agricultural Production
Agronomy & Crop Science
Animal Sciences
Food Sciences & Technology
Horticulture Operations & Management
Horticulture Science
Natural Resources Conservation, General
Environmental Science
Forestry
Natural Resources Management
Wildlife & Wildlands Management
Other
29
Architecture
Architecture, General
Architectural Environmental Design
City/Urban/Regional Planning
Interior Architecture
Landscape Architecture
Other
30
Area, Ethnic & Multidisciplinary Studies
Area Studies, General (e.g., African, Middle Eastern)
Asian Area Studies
European Area Studies
Latin American Area Studies
North American Area Studies
Ethnic & Minority Studies, General
African American Studies
American Indian/Native American Studies
Latino/Chicano Studies
Women’s Studies
Liberal Arts & General Studies
Library Science
Multi/Interdisciplinary Studies
Other
31
Arts: Visual & Performing
Art, General
Art History, Criticism & Conservation
Fine/Studio Arts
Cinema/Film
Cinematography/Film/Video Production
Dance
Design & Visual Communications, General
Fashion/Apparel Design
Graphic Design
Industrial Design
Interior Design
Music, General
Music, Performance
Music, Theory & Composition
Photography
Theatre Arts/Drama
Other
32
Business
Accounting
Accounting Technician
Business Administration & Management, General
Hotel/Motel Management
Human Resources Development/Training
Human Resources Management
International Business Management
Labor/Industrial Relations
Logistics & Materials Management
Marketing Management & Research
Office Supervision & Management
Operations Management & Supervision
Organizational Behavior
Purchasing/Procurement/Contracts Management
Restaurant/Food Services Management
Small Business Management/Operations
Travel/Tourism Management
Business/Management Quantitative Methods, General
Actuarial Science
Business/Managerial Economics
Finance, General
Banking & Financial Support Services
Financial Planning & Services
Insurance & Risk Management
Investments & Securities
Management Information Systems
Real Estate
Sales, Merchandising, & Marketing, General
Fashion Merchandising
Tourism & Travel Marketing
Secretarial Studies & Office Administration
Other
33
Communications
Communications, General
Advertising
Digital Communications/Media
Journalism, Broadcast
Journalism, Print
Mass Communications
Public Relations & Organizational Communication
Radio & Television Broadcasting
Communications Technology, General
Graphic & Printing Equipment Operation
Multimedia/Animation/Special Effects
Radio & Television Broadcasting Technology
Other
34
Community, Family, & Personal Services
Family & Consumer Sciences, General
Adult Development & Aging/Gerontology
Child Care Services Management
Child Development
Consumer & Family Economics
Food & Nutrition
Textile & Apparel
Parks, Recreation, & Leisure, General
Exercise Science/Physiology/Kinesiology
Health & Physical Education/Fitness
Parks/Rec/Leisure Facilities Management
Sport & Fitness Administration/Management
Personal Services, General
Cosmetology/Hairstyling
Culinary Arts/Chef Training
Funeral Services & Mortuary Science
Protective Services, General
Corrections
Criminal Justice
Fire Protection & Safety Technology
Law Enforcement
Military Technologies
Public Administration & Services, General
Community Organization & Advocacy
Public Administration
Public Affairs & Public Policy Analysis
Social Work
Other
35
Computer Science & Mathematics
Computer & Information Sciences, General
Computer Networking/Telecommunications
Computer Science & Programming
Computer Software & Media Applications
Computer System Administration
Data Management Technology
Information Science
Webpage Design
Mathematics, General
Applied Mathematics
Statistics
Other
36
Education
Counseling & Student Services
Educational Administration
Special Education
Teacher Education, General
Curriculum & Instruction
Early Childhood Education
Elementary Education
Junior High/Middle School Education
Postsecondary Education
Secondary Education
Teacher Assisting/Aide Education
Teacher Education, Subject-Specific
Agricultural Education
Art Education
Business Education
Career & Technical Education
English-as-a-Second-Language Education
English/Language Arts Education
Foreign Languages Education
Health Education
Mathematics Education
Music Education
Physical Education & Coaching
Science Education
Social Studies/Sciences Education
Other
37
Engineering
Engineering (Pre-Engineering), General
Aerospace/Aeronautical Engineering
Agricultural/Bioengineering
Architectural Engineering
Biomedical Engineering
Chemical Engineering
Civil Engineering
Computer Engineering
Construction Engineering/Management
Electrical, Electronics & Communications Engineering
Environmental Health Engineering
Industrial Engineering
Mechanical Engineering
Nuclear Engineering
Other
38
Engineering Technology & Drafting
Drafting/CAD Technology, General
Architectural Drafting/CAD Technology
Mechanical Drafting/CAD Technology
Engineering Technology, General
Aeronautical/Aerospace Engineering Technologies
Architectural Engineering Technology
Automotive Engineering Technology
Civil Engineering Technology
Computer Engineering Technology
Construction/Building Technology
Electrical, Electronics Engineering Technologies
Electromechanical/Biomedical Engineering Technologies
Environmental Control Technologies
Industrial Production Technologies
Mechanical Engineering Technology
Quality Control & Safety Technologies
Surveying Technology
Other
39
English & Foreign Languages
English Language & Literature, General
American/English Literature
Creative Writing
Public Speaking
Foreign Languages/Literatures, General
Asian Languages & Literatures
Classical/Ancient Languages & Literatures
Comparative Literature
French Language & Literature
German Language & Literature
Linguistics
Middle Eastern Languages & Literatures
Spanish Language & Literature
Other
40
Health Administration & Assisting
Health Services Administration, General
Hospital/Facilities Administration
Medical Office/Secretarial
Medical Records
Medical/Clinical Assisting, General
Dental Assisting
Medical Assisting
Occupational Therapy Assisting
Physical Therapy Assisting
Veterinarian Assisting/Technology
Other
41
Health Sciences & Technologies
Chiropractic (Pre-Chiropractic)
Dental Hygiene
Dentistry (Pre-Dentistry)
Emergency Medical Technology
Health-Related Professions & Services, General
Athletic Training
Communication Disorder Services (e.g., Speech Pathology)
Public Health
Health/Medical Technology, General
Medical Laboratory Technology
Medical Radiologic Technology
Nuclear Medicine Technology
Respiratory Therapy Technology
Surgical Technology
Medicine (Pre-Medicine)
Nursing, Practical/Vocational (LPN)
Nursing, Registered (BS/RN)
Optometry (Pre-Optometry)
Osteopathic Medicine
Pharmacy (Pre-Pharmacy)
Physician Assisting
Therapy & Rehabilitation, General
Alcohol/Drug Abuse Counseling
Massage Therapy
Mental Health Counseling
Occupational Therapy
Physical Therapy (Pre-Physical Therapy)
Psychiatric/Mental Health Technician
Rehabilitation Therapy
Vocational Rehabilitation Counseling
Veterinary Medicine (Pre-Veterinarian)
Other
42
Philosophy, Religion, & Theology
Religion
Theology, General
Bible/Biblical Studies
Divinity/Ministry
Religious Education
Other
43
Repair, Production, & Construction
Aviation & Airway Science, General
Aircraft Piloting & Navigation
Aviation Management & Operations
Construction Trades (e.g., carpentry, plumbing, electrical)
Mechanics & Repairers, General
Aircraft Mechanics/Technology
Autobody Repair/Technology
Automotive Mechanics/Technology
Avionics Technology
Diesel Mechanics/Technology
Electrical/Electronics Equip Installation & Repair
Heating/Air Cond/Refrig Install/Repair
Precision Production Trades, General
Machine Tool Technology
Welding Technology
Transportation & Materials Moving (e.g., air, ground, & marine)
Other
44
Sciences: Biological & Physical
Biology, General
Biochemistry & Biophysics
Cell/Cellular Biology
Ecology
Genetics
Marine/Aquatic Biology
Microbiology & Immunology
Zoology
Physical Sciences, General
Astronomy
Atmospheric Sciences & Meteorology
Chemistry
Geological & Earth Sciences
Physics
Other
45
Social Sciences & Law
Legal Studies, General
Court Reporting
Law (Pre-Law)
Legal Administrative Assisting/Secretarial
Paralegal/Legal Assistant
Social Sciences, General
Anthropology
Criminology
Economics
Geography
History
International Relations & Affairs
Political Science & Government
Psychology, Clinical & Counseling
Psychology, General
Sociology
Urban Studies/Urban Affairs
Other
46
If "Other", please specify:
47
College Transcripts* This field is required.College students need to include BOTH high school and college transcripts. For Keppy applications: If both high school and college transcripts are not included, your application will not be reviewed
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
48
Current College GPA:* This field is required.
49
College activities, community activities, volunteer work, honors, offices held:* This field is required.
50
Do your parents farm?* This field is required.
YESNO
51
Do you personally receive $2,500 or more from the sale of Ag products, services, and/or cash rent?* This field is required.
YESNO
52
Are you involved in a farming operation?* This field is required.
YESNO
53
Do you have specific duties in the farming operation?* This field is required.
YESNO
54
What are your duties/responsibilities in the above mentioned farming operation?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
55
Please choose the category for the applicants' adjusted gross income for the past year.* This field is required.
Did Not File
Less than $20,000
$20,001-$40,000
Over $40,000
56
Please choose the category for the parents' combined adjusted gross income for the past year* This field is required.
$20,000-$40,000
$40,001-$60,000
$60,001-$80,000
$80,001+
57
List any financial scholarships and grants you have received to date toward your future schooling:* This field is required.
Huge
Large
Normal
Small
Ok
Ok
58
How many children are living at home (exclude yourself):* This field is required.
59
How many are attending college (exclude yourself):* This field is required.
60
Where?
Huge
Large
Normal
Small
Ok
Ok
61
Scholarship amount received per person:
Huge
Large
Normal
Small
Ok
Ok
62
Have you previously received a Keppy Scholarship?* This field is required.
YESNO
63
Have you previously received a Stulz Scholarship?* This field is required.
YESNO
64
You are eligible for the Foundation Scholarship. Would you like to be considered for this scholarship?* This field is required.
Yes
No
65
You are eligible for the Keppy Scholarship. Would you like to be considered for this scholarship?* This field is required.
Yes
No
66
You are eligible for the Bush Scholarship. Would you like to be considered for this scholarship?* This field is required.
Yes
No
67
You are eligible for the Stulz Scholarship. Would you like to be considered for this scholarship?* This field is required.
Yes
No
68
Production Agriculture was a very prominent role in the life of the Keppy family, and represents a large segment of the Rock Island County Farm Bureau membership and heritage. Wilbert and Carol Keppy were very committed to supporting their community. Their commitment to community and agriculture is represented today in their belief to give back with their philanthropic legacy.
69
Essay* This field is required.Explain to the scholarship selection committee, "Do you see an individual responsibility to promote agriculture? If so, why, and how would you accomplish doing so?”
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
70
Post-Collegiate Career Goals Statement* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
71
Attach a current head shot photo for use in Foundation publications.* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
72
Letter of Recommendation* This field is required.Please list below one person whom you will request to complete a recommendation letter in support of your application. We recommend a reference be from an employer, teacher or current academic adviser. Letter of recommendation must be no more than one year old at the time of application. Applicants are responsible for ensuring that the letter of recommendation be received by the deadline date.
Reference Letters can be mailed to the Rock Island County Farm Bureau Foundation, Attn. Scholarship Committee, 1601 52nd Ave, Suite 3, Moline, IL 61265
73
Additional InformationWhat additional information about yourself do you wish to share that might be relevant to this application?
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
74
It has been requested by the Scholarship Selection Committee and Foundation Board that an interview may be requested for certain applicants. By indicating "yes" below you agree to attend in person or via a Skype interview during the week of April 17, 2023, if needed. I agree to complete the application process by participating in an interview in person or via Skype.* This field is required.
Yes
No
75
I certify that to the best of my knowledge the information contained in this application is true and correct. I also understand that I am a student in good academic standing. I understand this application will not be considered for review unless I have indicated "yes" in the "yes" box below. I also understand that the application will not be complete until the letter of recommendation, essay, and transcript are received no later than the deadline date. It is also my understanding that NO MATERIALS WILL BE RETURNED. I also understand that as an applicant for the Keppy Scholarship I may be asked for an oral interview and failure to attend the interview may negatively affect my ability to receive the Keppy Scholarship. Furthermore, I understand that an Awards Luncheon for all 2023 Scholarship winners and parents will be held on Tuesday May 16, 2023 at 11:30 and if I am selected as a winner, I will make every attempt to attend the luncheon sponsored by the Rock Island County Farm Bureau Foundation. This statement will serve as notice that if the student withdraws, drops out of school, OR drops below full-time status, the monies from the Foundation will be payable back to the Foundation.* This field is required.
Yes
76
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
77
Date
Date
Month
Day
Year
78
E-Signature:* This field is required.
Should be Empty:

Save your progress

Save your progress

Your form submission has been saved as a draft.

Save your progress

Your form submission has been saved as a draft.