FORM CLOSED: National Exchange Bank Scholarship Application

Form Closed: 2022 National Exchange Bank Scholarship Application

National Exchange Bank & Trust is pleased to offer scholarships administered by the Fond du Lac Area Foundation to the sons and daughters of active National Exchange Bank employees. Students are judged on financial need, academic achievement, school involvement, work experience, community and volunteer involvement and a personal statement. Renewable scholarships are available for $4,000 per year for a baccalaureate degree and $3,000 per year for a technical college degree.

Applications must be submitted by March 31, 2022. The FDL Area Foundation expects to notify applicants of awards by May 31, 2022.

Personal Information

Student First Name

Middle

Student Last Name

Permanent Address Line 1

Permanent Address Line 2

City

State

ZIP

Email Address

Phone Number

Birth Date

Are you considered a financially dependent child of an active NEBAT Employee? Yes No

NEBAT-Employed Parent Name, and Address, if different:

NEBAT-Employed Parent First Name

NEBAT-Employed Parent Last Name

Address Line 1

Address Line 2

City

State

ZIP

Primary NEBAT Location/Office

Post-Secondary School Information

Please indicate which scholarship you wish to apply for: 4 year College / University 2 year Technical College

College Admission

Have you applied for college admission? Yes No

Have you been accepted / admitted? Yes No

School Preference

What is your preferred school?

Enrollment Status

First Year Student

Continuing Student

Number of credits completed

College Expenses

Estimated financial expense for coming year (before any grants/scholarships have been applied):

Do you plan to live on campus? Yes No

Paying for College

How do you plan to pay for college? (Estimate percentage of each that apply; total of 100%.)

Parent/Guardian Assistance

Personal Savings

Scholarships

Student Loans

Grants

Work During School (include estimated hours/week)

Other (please specify)

Scholarships & Grants

List any scholarships or grants you have been awarded for the coming academic year.

Please format as follows:

Company/Organization Name - Amount

Scholarships or Grants:

Academic and Other Relevant Data

High School/ College Name

High School / College Address Line 1

High School / College Address Line 2

City

State

ZIP

Complete as Applicable

High School GPA (on a scale of 4.0)

Graduation Date

College / University GPA (on a scale of 4.0)

Optional statement about course work, honors or other academic circumstances/achievements (limit to 500 characters):

Education Major

Education Minor (if applicable)

When do you expect to graduate from College / University?

List your hobbies and skills and tell why they are important to you (limit to 500 characters):

Activities

Please fill out the below fields for extracurricular activities, community activities and work experiences. If you wish to format on your own, you may upload a document containing the required information for all three sections.

Extracurricular Activties, Community Activities & Work Experiences

Maximum 7 MB

Extracurricular Activities

List the top 5 extracurricular activities in which you have been most involved, in order of importance to you. Include the activity name, year(s) participated, approximate time spent in hrs/wk and wks/yr and any positions held or awards received.

Extracurricular Activities

Community Activities

List the top 5 community activities in which you have been most involved including your junior year in high school and/or after. Please include the organization name, year(s) participated, and approximate time spent in hrs/wk & wks/yr.

Community Activities

Work Experiences

List up to 5 work experiences during high school and/or technical school, college or university, most recent first. Please include the company/organization name, title/basic duties, start date, end date and the hrs/wk.

Work Experiences

Transcripts

Please attach a copy of your high school and/or college transcripts with cumulative GPA and name of school included.

High School Transcript

Maximum 7 MB

College Transcript

Maximum 7 MB

Personal Statement

Complete and attach a one-page personal statement (maximum of 250 words) highlighting your educational and career goals, with emphasis on financial need. Demonstration of financial need will be weighed heavily. The personal statement includes information required for the scholarship committee to consider in conjunction with your completed application and transcripts.

Personal Statement

Maximum 7 MB

Verify that you plan to attend a 2 or 4-year college full time as a degree seeking candidate

Post-secondary - full-time status as defined by the applicable school for the coming term

Verify that you plan to attend a 2 or 4-year college full time as a degree seeking candidate. Post-secondary (full-time status as defined by the applicable school for the coming term)

“I certify that the information submitted on this application is complete and accurate to the best of my knowledge, and I understand that knowingly submitting inaccurate or false information may result in the denial and/or rescinding of scholarships.”

I have attached the following documents to this application

Personal Statement Maximum of 250 words

Copy of High School and/or College Transcripts with Cumulative GPA and Name of School Included

Graduation or other recent picture of myself

First Name

Last Name

Current Photograph of Yourself

Please upload a current photograph of yourself (headshot preferred) for publicity if you are chosen as a winner.

Minimum: 2.5” x 3.5” at 200 dpi

Current Photograph

Maximum 7 MB

Waiver/Release

I hereby grant National Exchange Bank & Trust (NEBAT), its representatives and employees the unrestricted right to use, reproduce and publish the information in this document, along with the accompanying photograph, for editorial, trade, printed or electronic publications, web sites or other electronic communications. The information and photograph may be used in any manner or media without notifying me, such as newsletters, brochures, websites, promotions, advertising, and in any other publications produced for NEBAT. I further agree that my name and identity may be revealed in descriptive text or commentary in connection with such use. I waive the right to inspect or approve the finished version(s) of the products. I authorize the use of the information and photograph without compensation to me.

I hereby release National Exchange Bank & Trust, its representatives and employees from any and all claims, actions and liability which may arise directly or indirectly out of the use of the information, photo, likeness, name or comments.

I understand that I may revoke this consent by providing a written notice to NEBAT. I understand that my revocation will not affect the continued use of anything which has already been published, disseminated or is already in the process of development for publication or use by NEBAT at the time of the revocation. I also understand that my revocation will have no effect on anything which has become a public record or matter of public interest.

This is a voluntary consent. I understand there will be no negative consequences for choosing not to sign.

I have read this release before signing and I freely accept the terms.

Signature First Name

Signature Last Name

If under 18, the signature of a parent / guardian is required.

Parent Signature First Name

Parent Signature Last Name