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Farm & Industry Short Course Admission and Scholarship Application

Instructions

If you cannot use this online application, email (fisc@cals.wisc.edu) or call (608-263-3918) the Farm & Industry Short Course office for assistance.

By filling out this application, you are:

1. applying for admission to the Farm & Industry Short Course program, and
2. applying for any FISC scholarships for which you are eligible.

Applications received by April 1, 2010 will be considered for both admission and scholarships.

Applications received after April 1, 2010 will be considered for admission. They will be considered for scholarships only if there are unallocated scholarship funds remaining after the initial allocation process.

Applications received after October 1, 2010 will not be considered.

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In addition to completing this online application, you must send us via postal mail:

1. An official transcript showing your cumulative grade point average. The transcript must be from the educational institution you most recently attended (high school, college, or other post scondary institution).
2. $100 dormitory room deposit if you are reserving a room.
   1. Make check payable to "Short Course Dorms".
   2. This deposit is refundable until October 1, 2010.
3. One letter of recommendation. Possible sources include: teachers, ag leaders, county agents, members of the clergy, business people, neighbors, and high school counselors. Letters should address: financial need, activities, leadership, and academic performance.

Send the above items to:

Director of Short Course
University of Wisconsin-Madison
1450 Linden Drive, Room 116
Madison, WI 53706

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The criteria for allocating scholarships in CALS vary depending on the award. Criteria for selection may include: academic achievement, personal qualifications, financial need, career interests, major or program interest. The Farm & Industry Short Course Scholarship and Financial Needs Committee selects the scholarship and award recipients.

Students selected for awards will receive their funds in three installments: 40% will be disbursed at the beginning of the first term, 20% at the beginning of the second term, and 40% at the beginning of the third term in the 2010-2011 academic year.

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You must complete this application in one session. Please read the entire application and gather all the information you need before you begin filling it out.

Your application has not been submitted until you check the "I certify..." statement and click the submit button at the bottom of this page. After you submit your application, you will receive a confirmation page. Print the confirmation page for your records. You will need your confirmation number to communicate further with us regarding your application.

Close your browser when you are done to prevent others from seeing your information.

Questions? Problems? Contact us at fisc@cals.wisc.edu or (608) 263-3918.

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Personal Information

Name:	First	MI	Last
Gender:	female male
Social Security Number:	(number only)
Date of Birth:	(mm/dd/yyyy)
Place of Birth:	City	State (WI, MN, IL, etc)	Country (if not U.S.)
Are you a U.S. Citizen?	No Yes
Country of Citizenship:	(if not U.S.)
Legal Residence:	Select a residence type... Urban Small Town Rural Non-farm Farm  Type	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other  State (if in U.S.)	Adams Ashland Barron Bayfield Brown Buffalo Burnet Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond Du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee La Crosse La Fayette Langlade Lincoln Manitowac Marathon Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk Sauk Sawyer Shawano Sheboygan St. Croix Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood  County (if in WI)
Name of Parents or Guardians:
Father's Occupation:
Mother's Occupation:
Do you have a disability for which you may need assistance or attention?			No Yes
Ethnicity Are you of Hispanic or Latino/a origin?   No Yes If yes, choose one or more from this list. Cuban Mexican, Mexican American, Chicano/a Puerto Rican Other Hispanic or Latino/a		Race Choose one or more from the list below. African American or Black American Indian or Alaska Native     Tribal Affiliation: Native Hawaiian or Pacific Islander Cambodian Hmong Laotian Vietnamese Other Asian White

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Contact Information

Permanent
Address:	Street	City	State	Zip Code	Country (if not U.S.)
Home Phone: (include area code)
Mailing (Local)
Address:	Street	City	State	Zip Code	Country (if not U.S.)
Home Phone: (include area code)
Email Address: Cell Phone:  (include area code)
Hometown Newspaper
Name: Email Address:

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Education

High School
School Name:
Location:	city, state, country (if not U.S.)
Did you graduate?	No Yes	If yes, what year?
Counselor:	Name	Email	Phone (include area code)
Education Beyond High School
School Name:
Location:	city, state, country (if not U.S.)
Dates Attended:		Degree Earned (if any):

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Dormitory

Do you need a dormitory room?	No Yes
A $100 deposit is required to reserve a dormitory room. Make check payable to "Short Course Dorms". See above for mailing information.

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Financial Information

All financial information is confidential. Some scholarships require evidence of financial need. If you choose not to complete this section of the application, you will not be considered for these awards.

I choose to provide this financial information:

No Yes

If you are financially independent, answer these questions based on your own income and situation. If you are not financially independent, answer these questions based on your parents' income and situation. To be considered self-supporting or financially independent, you must meet the following definition of self-supporting (parental income and assets will not be considered): (1) 24 years of age or older by 12-31-09; or (2) be an orphan or ward of the court; or (3) be a veteran of the U.S. Armed Forces; or (4) be a graduate or professional student; or (5) be married; or (6) have legal dependents other than a spouse.

Are you financially independent?	No Yes
Number of dependents:	(number only)
Number of dependents in college excluding applicant:	(number only)
Adjusted Gross Income** for previous year:	Select an income range... Less than $20,000 $20,000-$30,000 $30,000-$40,000 $40,000-$50,000 $50,000-$70,000 $70,000-$90,000 $90,000-$100,000 more than $100,000
Planned student contribution for 2010-11:	(number only)
Planned family contribution for 2010-11:	(number only)

Explain any special circumstances including sources of income or hardship not reflected in your answers above:

** Adjusted Gross Income: IRS Form 1040 - line 37; Form 1040A - line 21; form 1040EZ - line4.

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Accomplishments, Interests and Special Considerations

Career Areas

Check all that interest you.

Crop and Soil Management Dairy Farm Management Farm Mechanics Farm Service and Supply

Green Industry Horticulture Meat Animals and Poultry Pasture-based Dairy/Livestock

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Special Considerations

Check all that apply to you.

	My family lived on a farm when I was born.
	I live, or have lived, on a farm. Years Spent on Farm: (number only)
	I am, or my parents are actively farming. Type of Farm Enterprise:
	I am a UW Farm & Industry Short Course first year graduate.
	I am or was an FFA member. Years as FFA Member: (number only) FFA Offices Held:
	I am or was a 4-H member. Years as 4-H Member: (number only) 4-H Offices Held:

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Current Involvement

Describe your current involvement in agriculture or horticulture.

My current involvement in Agriculture or Horticulture is ...

Extra Curricular, Volunteer, Leadership and Community Activities

Use the grid below to list your participation in high school and post-high school extra curricular school and non-school activities (such as a part-time job or religious activity). Indicate the number of years that you have been involved in the activity. Examples are given on the first four lines.

Activity or Leadership Position	H.S. Activity	Leadership Title	# Years Participated
Example: Church Youth Group			3
Example: Wrestling		Captain	4
Example: FFA			2
Example: Part-time job on vegetable farm			1

Honors and Awards

Use the grid below to list Honors and Awards you have received. An example is given on the first line.

Name of Honor or Award	Date Received
Example: 4-H Club Service Award	December 2009

 

I certify that the information given in this application is correct and complete to the best of my knowledge.

Your application has not been submitted until you check the "I certify..." statement above and click the submit button.

After you submit your application, you will receive a confirmation page. Print the confirmation page for your records. You will need your confirmation number to communicate further with us regarding your application.

Questions? Problems? Didn't get a confirmation page? Contact us at fisc@cals.wisc.edu or (608) 263-3918.