2008 Wisconsin Towns Association

Scholarship Program
Background Information

Name _________________________________________(  ) Male  (  ) Female

Telephone Number _______________________________________________

Mailing Address _________________________________________________

City/State/Zip ___________________________________________________

Local Unit of Government in which you reside:

                  (  ) Town   (  ) Village  or (  ) City of ________________________

                   County of _______________________________

Parents’ Names __________________________________________________

Is either parent a town or village officer?  (  ) Yes   (  ) No

If “yes” please specify office held ____________________________________

Name of High School from which you are graduating in 2008?

_______________________________________________________________

School or institution of higher education you plan to attend after

Graduation? _____________________________________________________

Date of intended enrollment? ________________________________________

Career you plan to pursue? __________________________________________

Hobbies or activities in high school of interest to you?____________________

_______________________________________________________________

_______________________________________________________________

Your signature _____________________________________Date __________

Mail this completed form and your essay to the following address by

May 27, 2008            Wisconsin Towns Association

                                   W7686 County Road MMM

                                    Shawano, Wis.  54166-6086