Foundation Scholars Program

Applicant's Name:*

First Last

Home Address:*

Street Address City State ZIP Code

Applicant's Cell Phone:*

Applicant's Email Address:*

College/University attending in Fall 2025:*

Parents' Names:*

Parents' Occupations:*

College Student ID Number (if available):

(Used only to deposit scholarship funds into your student account)

Degree path or area of study:*

Current year in school:*

Expected college graduation date:*

(Please notify the CCFB Foundation should you choose to attend a college or university other than that specified above.)

High school attended:*

HS graduation date:*

How did you hear about our Scholarship Program? (Choose one)*

ACADEMICS (15 points)

Current Cumulative GPA:*

Composite ACT Score:*

Note: We understand that some students may only take the SAT. If you've only taken the SAT please enter that score in this area in place of an ACT Score.

Composite SAT Score:*

Note: We understand that some students may only take the ACT. If you've only taken the ACT please enter that score in this area in place of an SAT Score.

Attach Academic Transcript:*

High School Seniors - Please attach to this application a transcript confirming GPA, and ACT/SAT score. College Students - Please attach to this application your most recent transcript.

Accepted file types: pdf, Max. file size: 1 MB.

Agricultural Impact (35 points)

Please tell us about your agricultural experience: Using the space provided please highlight the two most impactful agricultural activities you’ve been a part of. How have they helped you to discover your niche in agriculture? How will you utilize these experiences in your education, or eventual career?

1)*

2)*

Community Impact (15 points)

In the spaces provided, please tell us about your impact on the community: Please provide examples of the three most meaningful or influential community or school activities in which you have participated. Using the space provided, explain how or why these experiences impact your personal growth. Examples could be from academic, school or campus activities, clubs, athletic, faith-based initiatives, community involvement, work history, or any other influential life experience. (5 points each).

1)*

2)*

3)*

INTERVIEW (35 points)

A 15-minute in-person or Zoom interview will be held with qualified applicants later in February. All applicants will receive an email on or before February 10th with a link to sign up for an interview slot. Interview times will be filled on a first-come, first-served basis. Your application will not be judged if you fail to appear for an interview.

*The interview committee and CCFB Foundation will make reasonable accommodations to complete this interview. Any requests to reschedule an interview must be made at least 24 hours in advance of your scheduled interview time.

More information regarding your interview will be sent to your email address on or before February 10th. Please watch for an email from CCFB Foundation Executive Director Kirk Builta kirk@ccfarmbureau.com*

* I understand an interview will be part of this application process and agree to meet with the interview committee.
More information regarding your interview will be sent to your email address on or before February 10th. Please watch for an email from CCFB Foundation Executive Director Kirk Builta kirk@ccfarmbureau.com

TOTAL APPLICATION — 100 points

Extra Credit - 3 points max

In the past year, I've volunteered with the CCFB Foundation at the following events.
Foundation Gala
Cash Bash
Golf Outings
Ag in the Classroom
Other

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