Date:___________________
Name (Last): _________________________ (First): _____________________ M.I._________
Address: (Street or PO Box): _____________________________________________________
City: _____________________ State: _________ Zip: ____________
Telephone Number with area code: _____________________________________
Date of Birth: ___________________ Email address: _________________
EMPLOYEE: please provide job title and dates of employment:
_______________________________________________________________________
CHILD OF EMPLOYEE: please provide parent's job title and dates of employment:
________________________________________________________________________
To which University/College/School would this scholarship apply?
__________________________________________________________________
Mailing address of University/College: ________________________________________
Please complete the following:
Name/address of High School you attended: ________________________________________________________________________
Class Rank: ___________ Class Size: ____________ Cumulative G.P.A.: ____________
I hereby acknowledge that the information submitted herewith is true and correct._____________________________________________________
(Signature and Date)
On separate form, please supply:
- 250-word typed essay describing the positive influences that your employment at 7 Mile Fair, Inc has had on your life.
- Descriptions of any extracurricular activities, community service or other activities you were involved in.
Return to:
Scholarship Selection Committee
7 Mile Fair, Inc.
2720 W 7 Mile Road
PO Box 7
Caledonia, WI 53108-0007
262.835.2177
www.7milefair.comEmail:
7milefair@execpc.com