Ag Benefit Scholarship Application - Agricultural Commissioner

Ag Benefit Scholarship Application

Any missing information or documentation may deem the application as incomplete and may be disqualified.

Applicant Information

Full Name *

Date of Birth

Month

Day

Year

Current Address *

Apartment, suite, etc

City *

Mailing Address (if different from above)

Apartment, suite, etc

City

Cell Phone Number *

Home Phone Number

Email Address (Student) *

Email Address (Parent) *

High School Information

Name of High School *

Overall GPA (must provide a copy of most current official high school transcript) *

Upload copy of official transcript

No file chosen

University/College/Trade/Vocational/Technical School Information

University/College/Trade/Vocational/Technical School *

Major *

Student ID Number (Can be provided when available)

Current Overall GPA (if applicable, must provide a copy of official transcript)

Upload copy of official transcript

No file chosen

Mailing Address of University *

Office, building, suite, etc

City *

State/Province *

ZIP / Postal Code *

Reference

One reference will be required to complete an online reference form and submit it before the deadline, or your application will be marked as incomplete and may be disqualified.

Name *

Email Address *

Relationship *

Phone *

Essay Prompt

How do you plan to apply your education to benefit Imperial County Agriculture?

(Limit 300 words)

I agree *

By submitting this application, I hereby declare that the information provided is true and correct. I also understand that any willful
dishonesty may render for refusal of this application or immediate disqualification.

Save as Draft

If you have any questions please call our office at 442-265-1500 or e-mail agbenefitscholarship@co.imperial.ca.us