ORVILLE BENNET MEMORIAL SCHOLARSHIP

APPLICATION FORM 2007

This application must be returned before May 31, 2005 to the Orville

Bennet Memorial Scholarship Committee, P.O. Box 140225

Austin, Texas 78714.

NAME OF APPLICANT: __________________________________

ADDRESS: ______________________________________________

                    ______________________________________________

Parent or Guardian: __________________ P.O., Station, Tour _______________

Number of Dependents in family _____ Home Phone ________________

Have you followed a college preparatory course? _____ If so which one?________

_________________________________________________________________

What is your present occupational interest? _______________________________

__________________________________________________________________

List your extracurricular activities for your junior /senior years in high school.

In school __________________________________________________________

__________________________________________________________________

__________________________________________________________________

In the community ___________________________________________________

__________________________________________________________________

Where do you plan to go to college? _____________________________________

Have you ever been granted or have applied for another scholarship? ______

If so, which one and for how much? ______________________________________

___________________________________________________________________

Name of a teacher we could contact for information about your self:

___________________________________ Phone number ____________________

********************************************************************

YOU MUST ENCLOSE A COPY OF YOUR MOST RECENT HIGH

SCHOOL TRANSCRIPT AS WELL AS A SHORT SUMMARY OF

YOUR ACCOMPLISHMENTS AND GOALS FOR THE FUTURE.

********************************************************************

Union use only.  Date application received ____________________

Parent is a member in good standing _______ Union signature __________________