Scholarship Application
Eligibility:
The District 17 Club Council Scholarship is designed to recognize a rider embodying principles of good scholarship, sportsmanship, citizenship and participation in District 17 events. The District 17 Board of directors can award a Scholarship based on the recommendation of The Scholarship Committee in the amount of $ 500.00 to one or more riders who meet the following criteria. Applicants must be a full-time student in an accredited high school with senior standing, or currently enrolled student at an accredited community college, college or university, or Vocational/technical School. Applicants must be a District 17 member and ride in one or more District 17 events during the year in which the application is filed. The Scholarship Committee will consider grades, participation in extracurricular activities, participation in community activities, participation in District 17 events. The following application must be completed to be eligible for consideration for the District 17 Club Council Scholarship.
Date ____/____/____
Applicant Name ________________________________________________ Date of Birth ___/___/___
Address ______________________________________________ Phone Number (_____) ____-______
City ____________________________________________________ State __________ ZIP_________
Parent Name ____________________________________ Phone Number (_____) ____-______
Address __________________________________________________________________________
City ____________________________________________________ State __________ ZIP_________
Currently enrolled in: (Check one and complete the required information)
Name of School ______________________________________________________________________
Address ____________________________________________________________________________
City __________________________________________________________ State ______ ZIP _______
Grade Point Average ______ Scale ______ Class Rank _______ Month / Year of Graduation ____/____
Extracurricular/ Community Activities ____________________________________________________
___________________________________________________________________________________
____________________________________________________________________________________
If currently attending high school what school will you be attending next:
Name of School ________________________________________________________________
Address ______________________________________________________________________
City ____________________________________________________ State ______ ZIP _______
Major field of study ___________________________________ Minor ____________________
Career Goal ___________________________________________________________________
Month and Year classes start _____/_____
If you have graduated high school
Major field of study ___________________________________ Minor ____________________
Career Goal ___________________________________________________________________
District 17 Member
Last District 17 event you rode:
Date ___/___/___ Type of event ___________________________ Class ___________________
Location ____________________________________________ Finishing Position __________
Motorcycle:
Make _________________________ Model __________________________ Year __________
List other District 17 events you rode this year:
Deadline:
Application must be received by September 15 of the current year.
Mail completed applications to:
George Barrington
442 S. Michigan Ave.
Villa Park, IL 60181