Due Date April 1, 2007
                                   Fort Atkinson Science Fair
                       2007 Science Scholarship Application Form

Name:  ____________________________________________________________________
                        (last)                                                               (first)                                              (middle)
Address: ___________________________________________________________________
                        (street)                                                  (city)                                    (state)             (zip)
Phone:            ______________  Graduating High School  ________________________

Father or Guardian's Name:_____________________________________________________
                                                        (last)                                                             (first)
Mother or Guardian's Name: ____________________________________________________
                                                        (last)                                                             (first)

Past participation in Fort Atkinson Science Fair
            Year (s) and Project title (s): 

___________________________________________________________

___________________________________________________________

___________________________________________________________

            Awards and recognition: ____________________________________________

College, University or Technical school you are planning to attend:

            ___________________________________________________________

When do you plan to begin:            ________________

Planned science career or degree:  ____________________________________

On attached sheet(s), please include a narrative on the following:
             1.      Describe your activities and interests, including extra-curricular school activities,
                      community and volunteer activities, jobs and individual projects.

2.      What inspired you to pursue your chosen field of study.  Consider your outside
   and extracurricular activities, individual projects and interests, jobs, supporting
   teachers or mentors, camps and other forms of encouragement.

References:  Please request two letters of recommendation from individuals who are familiar
with your work, your chosen field of post high school study, your accomplishments or
academic achievements. 

Application:  Attach the above, plus a copy of your high school transcript and send to:          

                                    Fort Atkinson Science Fair Scholarship Committee
                                    P.O. Box 371
                                    Fort Atkinson, WI 53538

Applicant's Signature:  ______________________________________  Date:  __________

This scholarship does not discriminate on the basis of sex, race, religion, national origin, ancestry, creed, pregnancy,
 marital or parental status, sexual orientation or physical, mental, emotional or learning disability or handicap.