Griffin Warniment Memorial Scholarship

GRIFFIN WARNIMENT MEMORIAL SCHOLARSHIP
Student Application

CRITERIA: To be eligible for this scholarship, you must be an undergraduate college student who is currently enrolled in a two or four year college, university or technical school. You must have a minimum grade point average of 2.8 to be considered for this award. This scholarship is open to all fields of study. Additionally, applicants must be able to be classified under one of the following statements.

* I have raced in a race event at Stateline Speedway in Edon Ohio

* I have raced in a Griffin Warniment Memorial Benefit Race at another race track.

* I am a parent of a racer that has raced at Stateline Speedway or Griffin Warniment Memorial Benefit Race at another track.

DIRECTIONS: All information must be filled out completely on the application form. Please PRINT or TYPE. Application must be postmarked on or before March 15th, 2008.

APPLICANT DATA

NAME: Last:________________________________ First:____________________________________ M.I.____________

ADDRESS: Street__________________________________________________________ Apt. / Dorm_________________

City_____________________________________ State_________________ Zip Code____________________

Phone (_______) ____________________________

EMAIL ADDRESS: _______________________________________________________

DATE OF BIRTH: Month_____________________ Day _____________ Year ____________________

PARENT /GUARDIAN (for Applicants under age 25 only)

Last _______________________________ First ___________________________

Home Phone (_________) _____________________________________________

SCHOOL DATA

Applicants must include an official college transcript of grades and complete the following section. Student generated online transcripts are not acceptable.

Currently (2007 - 2008), I am a college:

__________ Freshman __________ Sophomore __________ Junior __________ Senior

I will graduate from college: ____________________ Month _____________________ Year

Currently, my cumulative GPA is: __________ / 4.0 scale or __________ / __________ scale.

I CURRENTLY ATTEND:

School Name: ___________________________________________________________________________

School Address: Street ____________________________________________________________________

City ______________________________________ State ______________ Zip _________

School Phone: (__________) ________________________________

ORGANIZATIONS / ACTIVITIES / COMMUNITY VOLUNTEER SERVICES

Applicants must demonstrate outstanding achievement, exceptional leadership ability and a commitment to community service. Please list any organizations, activities, and community service with which you have played an active role (during the past two years). This may include any school related or extra curricular activities, clubs, organizations and or sports. Be sure to include your racing experience! Additionally, list any major awards you have attained or leadership positions you have held within the listed items. For example: Do not list each trophy you received throughout your racing career. Rather list only the highlights. (If more space is needed, you may continue on a separate page and attach it to this application.

______________________________________________________________________________________________________________

ESSAY

This essay may be up to, but no more than one 8.5 x 11 page, one sided, type written, and double spaced. Remember to proofread for spelling or grammatical errors.

ESSAY TOPIC: What characteristics have you developed and/or strengthened as a results of your racing involvement?

APPLICATION CHECKLIST:

The Application becomes complete and valid only when you have submitted:

__________ ESSAY __________ Application Form __________ Current and Complete Official Transcript of Grades

APPLICATION MUST BE POSTMARKED ON OR BEFORE MARCH 15th, 2008

CERTIFICATION

I certify that the information provided in this application is complete and accurate to the best of my knowledge. Falsification of any information will cause disqualification.

SIGNATURE OF APPLICANT ________________________________________________________________

DATE___________________________________________

MAIL TO:

Al and Laura Warniment

235 E. Third Street

Ottawa, OH 45875

If you have any questions, please call: (419) 523 - 0004