Michael Alcorn Scholarship Application

Application Deadline: April 1st of each year

To qualify for The Michael D. Alcorn Scholarship:

Submit this application. Review the questions and prepare your answers before completing the application as your information will not be saved if you leave this page before submitting the form.
Provide proof of high school graduation: an official copy of your high school transcript with seal or stamp or a copy of your General Education Diploma (GED).
Provide an official transcript (with seal or stamp) from a 4-year college or university indicating third semester, sophomore status through graduate school status.
Submit transcript(s) by email to Sharon Broster Walden or mail to:
Sharon Broster Walden
209 Loren Drive
Grayville, IL 62844

The directors of The Michael D. Alcorn Scholarship review the applications and announce the winner during the Grayville High School commencement.

Applications received after the deadline will not be considered.

Personal Information
Name*
First Middle Last
Email*
Phone*
Date of Birth*
Year of Graduation/GED*
Address*
Street Address City State ZIP Code
Father's Full Name
First Middle Last
Father's Occupation
Mother's Full Name
First Middle Last
Mother's Occupation
Number of children in family (including yourself)
Number of children living at home (including yourself)
Physical Grayville address (your address while living in Grayville)*
Street Address Address Line 2
Work Experience
SCHOOL YEAR WORK EXPERIENCE: List up to five paid work experiences, including self‐employment, for the past four years. Provide the following information (leave blank if you did not work during the school year):
School Year Work Experience
Name of employer Nature of work Hours worked per week Duration of employment
SUMMER WORK EXPERIENCE: List up to five paid work experiences, including self‐employment, for the past four years. Provide the following information (leave blank if you did not work during the summer):
Summer Work Experience
Name of employer Nature of work Hours worked per week Duration of employment
CURRENT EMPLOYMENT: In 150 words or less please address your current employment. If you are currently employed, why do you work? If you are NOT currently employed, why not?
Current Employment
Extracurricular Activities
COMMUNITY ACTIVITIES: In 150 words or less list up to six activities in which you participate – for example, volunteer activities, scouts, church/house of worship activities, civic groups, etc. – in the order of importance to you. Provide the following:
- Name of activity
- Year/s of participation
- Total hours of participation (the estimated number of hours you participated in the activity throughout your participation; e.g., 2 hours per week for 24 weeks for 3 years is 2 x 24 x 3 = 144 hours).
- Leadership positions, awards, recognition, etc.
Leave blank if you do not participate in community activities.
Community Activities
SCHOOL ACTIVITIES: In 150 words or less list up to six activities in which you participated – for example, clubs, student government, National Honor Society, Beta Club, etc. – in the order of importance to you. (Do NOT include sports.) Include only the hours spent outside the classroom. Provide the following:
- Name of activity
- Year/s of participation
- Total hours of participation (the estimated number of hours you participated in the activity throughout your participation; e.g., 2 hours per week for 24 weeks for 3 years is 2 x 24 x 3 = 144 hours).
- Leadership positions, awards, recognition, etc.
Leave blank if you do not participate in school activities.
School Activities
FINE ARTS ACTIVITIES: In 150 words or less, list up to six activities in which you participated – for example, music, drama, dance, debate, plays, etc. – in the order of importance to you. Provide the following:
- Name of activity
- Year/s of participation
- Total hours of participation (the estimated number of hours you participated in the activity throughout your participation; e.g., 2 hours per week for 24 weeks for 3 years is 2 x 24 x 3 = 144 hours).
- Leadership positions, awards, recognition, etc.
Leave blank if you do not participate in fine arts activities.
Fine Arts Activities
Personal Statements
In 100 words or less, briefly state the reasons you feel you are deserving of this scholarship.
Personal Statement Part 1
In 100 words or less, briefly describe any family, personal or financial circumstances which you think warrant consideration.
Personal Statement Part 2
By submitting this application for the Michael D. Alcorn Scholarship, I hereby certify the statements herein are true and correct to the best of my knowledge.
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Name of employer	Nature of work	Hours worked per week	Duration of employment

Name of employer	Nature of work	Hours worked per week	Duration of employment

Michael Alcorn Scholarship Application

Application Deadline: April 1st of each year

Personal Information

Work Experience

Extracurricular Activities

Personal Statements