FORM A – Personal Information
Enter the required information in the provided box above the label.
Name :					
	Last Name			First Name	Middle Initial	
	
Contact Info :					
	Phone Number		Alternate Phone	Email Address	
	
Tax Information :				
	Social Security #		Date of Birth	Birthplace (City, ST)	
	
Name of School Currently Attending :	
		
Name of School	City	
	
Address : 		
	Street Address	
				
	City			State	Zip	
	
Father :				
	Name		Occupation	
		
	Street Address	
				
	City		State	Zip	
			
	Phone		Bus. Phone	
	
Mother :					
	Name		Occupation		
		
	Street Address	
				
	City		State	Zip	
			
	Phone		Bus. Phone		
	
Siblings :			
	Name	Age	
			
	Name	Age	
			
	Name	Age	
			
	Name	Age	

FORM B - Opinions
What is the most pressing problem facing young people today?	
Enter your information here.

How would you deal with this problem?	
Enter your information here.

What makes you most proud of your generation?	
Enter your information here.

What makes you least proud of your generation?	
Enter your information here.

What is your college or post-secondary school preference and your intended major or area of interest?	
Enter your information here.

Comment briefly on reasons why you want to live and go to school in South Dakota.	
Enter your information here.

FORM C – Honors and Awards
List scholastic, athletic, performing arts, and community service honors, awards and special recognition you have received, including election to the Student Council and service as a class officer.  Do not include any which occurred prior to the 9th grade.  If you list more than 10, place an asterisk (*) before each of the 10 you consider to be the most significant.

Honor and Awards	
Enter your Honors and Awards	

	

	

	

FORM D – Community Service, Activities and Interests
List school, church and/or civic organizations, activities and projects with which you have been actively involved for the purpose of serving your community.  Also include involvement in clubs, performing art, athletic activities, and hobbies.  Briefly describe your involvement and approximate hours per year spent in each activity.  Limit list to 10.

Organization / Interest	Your Involvement	Hours	
Enter Information			

			

			

			

AGREEMENT AND SIGNATURE
I certify that the information provided is complete and accurate to the best of my ability.

			
Applicant’s Signature			Date