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* 1. Student's Full Name

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* 2. Student's Present Address and Phone Number (City, State, Zip)

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* 3. Student's Email Address

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* 4. Student's Age and Date of Birth

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* 5. Current GPA

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* 6. Name of Parents/Guardian

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* 7. Are you a CVA member or a dependent of a CVA member?

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* 8. Name of CVA Member-Owner (legal guardian) and Patron ID

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* 9. Name of High School attending

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* 10. FFA Chapter if applicable

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* 11. Name of Post-Secondary school attending in Fall of 2024

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* 12. Identify your Major

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* 13. Date of your High School Awards Ceremony

Date

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* 14. Major school and community activities including offices held in organizations (specify the year)

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* 15. Describe your College and Career Goals

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* 16. To date, What is your greatest accomplishment and why? 

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* 17. Why do you feel like you are a good candidate to receive this scholarship, and how will you represent your high school and community? 

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* 18. How is CVA important to you, your family or your family's operation? (please don't include any identifying information within your essay such as personal name or family name)

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* 19. Essay Topic: How can Cooperatives demonstrate their value to the next generation of agriculturists? 

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* 20. Upload a photo of yourself

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