Name____________________________________________________________

Address_________________________________________Phone_________________

City____________________________________State__________ZIP______________

FTA member   Yes     No

Relationship to an FTA member________________________________________

Name of above member _______________________________________________

High School__________________________________________________________

Date of graduation or pending graduation________________________________

School or college you are or plan on attending_____________________________________________________________

Major_________________________________________________

Proof of high school graduation and/or documentation indicating you have been accepted or are currently enrolled at an institution of higher education will be necessary. Please attach a short paper telling us about yourself, your career goals, and how this scholarship would help you achieve those goals. Due June 1, 2009. Mail to: