Newell School District

“Insuring a Brighter Tomorrow”
Scholarship Application
First & Last Name E-mail Address
Address Phone No. and/or Cell No.
City State Zip Code Date of Birth
Parents/Guardians Name Date of Graduation
___/___/2020
High School Attending
South Dakota College, University or Technical School Attending
Please check all that apply:
___Farmers Union Insurance Policyholder
___South Dakota Farmers Union Member
___Friends of the SDFU Foundation (defined as contribution of $25 or more during the past year)
___Participant of SDHSAA Sanctioned Activities
Check all SDHSAA sanctioned activities that you have participated in.
___ Basketball ___ Comp Cheer ___ Comp Dance ___ Cross Country
___ Football ___ Golf ___ Gymnastics ___ Sideline Cheer
___ Soccer ___ Tennis ___ Track & Field ___ Volleyball
___ Wrestling ___ Band ___ Debate ___ Chorus & Orchestra
___ Jazz Band ___ Journalism ___ One Act Play ___ Oral Interpretation
Check and/or list other high school clubs or activities you have participated in.
___ National Honor Society ________________ ________________ ___________________
___ Future Farmers of America ________________ ________________ ___________________
Check and/or list your community and volunteer involvement.
___ 4-H _____________________ _____________________ ____________________
_______________ _____________________ _____________________ ____________________
Please include only the following with your completed application.
Transcript, ACT Score or technical school exam score, Original wallet size senior picture & Essay
Please do not include any extra papers.
I acknowledge this information within the application is complete and accurate. I permit Farmers Union Insurance and
South Dakota Farmers Union Foundation to use my name and picture in any media.
Signature___________________________ Date__________
Please call Jenny @ 605-352-6761 ext. 162 with any questions.