Gothenburg State Bank Financial Achiever Scholarship Survey

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1. Applicant Information

Applicant Information Name:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

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2. What high school did you attend?

What high school did you attend? Gothenburg

Brady

3. Please list your top community service or group/organizations in which you have participated and describe your involvement (list activity, year(s), and involvement in each):

Please list your top community service or group/organizations in which you have participated and describe your involvement (list activity, year(s), and involvement in each): Activity/Group 1
Activity/Group 2
Activity/Group 3
Activity/Group 4

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4. Indicate the College or University you are planning to attend. If applications are still pending, indicate schools to which you have applied.

Indicate the College or University you are planning to attend. If applications are still pending, indicate schools to which you have applied. College/University 1
College/University 2
College/University 3

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5. What is your intended major?

What is your intended major?

6. Describe your career goals and why you have selected the college(s) and/or university(s) to which you have applied. (in 200 words or less)

Describe your career goals and why you have selected the college(s) and/or university(s) to which you have applied. (in 200 words or less)

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7. Indicate the following:

Indicate the following: Grade Point Average (GPA) on a 4.0 scale
Rank in Class (number only)

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8. Have you completed or are you in the process of completing the EverFi program?

Have you completed or are you in the process of completing the EverFi program? Yes

No

If no, please explain

9. Indicate your score on the following test(s)

Indicate your score on the following test(s) ACT
SAT

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10. How do you plan to meet your educational expenses?

How do you plan to meet your educational expenses?