The University of Iowa

Iowa Farm Scholarship/Iowa Basketball Lettermen FundApplication for the ______________ Academic Year

Applications received AFTER APRIL 1st will NOT be considered

The Iowa Farm Scholarship/Iowa Basketball Lettermen Fund was created to help Iowa farm familieswith the cost of educating their children. This scholarship is intended to help those families thathave been financially hurt by the recent problems in the farm economy. One of the Iowa FarmScholarships awarded each year will be granted in memory of Chris Street, an Iowa Basketballplayer killed in a 1993 traffic accident.

Part I APPLICANT BACKGROUND INFORMATION

PLEASE PRINT CLEARLY!!

Name: _________________________________ Social Security Number: ___________________

Address: __________________________________________________________________________ Street City and State Zip

nn How long has your family been a permanent resident of Iowa? ______________

nn How long has your family been farming in Iowa? ______________

nn Do you LIVE on the farm: ______________

nn High School attended: ___________________________________________________ Name City and State

nn The following information will be used when determining the recipient of the Chris Street Award: Did you participate in interscholastic athletics in high school? ______________

In which sport(s) did you participate? _____________________________________________________________________________________________________________

With our signatures below, we do attest that the information provided above is true and accurate

___________________________ ___________ __________________________ _________ Signature of Parent Date Signature of Applicant Date

Part II PERSONAL ESSAY

Attach an essay (maximum 2 double-spaced pages) describing how the current farm economy hasaffected your family’s ability to finance your education.

CRITERIA & GENERAL INFORMATION

nn You and your parents must be living on an Iowa farm and your parents must be operating thefarm

nn You must be ranked in the upper 25% of your graduating high school class

nn You must be a United States citizen

nn You must be an entering freshman planning to enroll full-time(12 or more hours per semester) ina degree program at the University of Iowa

nn The completed application, including your essay, must be returned to and received by theOffice of Student Financial Aid, Scholarship Department, 208 Calvin Hall, Iowa City, IA 52242, nolater than April 1st.

nn All applicants will be notified by mail of their award status by mid-August

Required Documents and Verification Materials

Scholarship applicant, PLEASE READ and COMPLETE THIS SECTION CAREFULLY!

�� Financial need will be a consideration, therefore all applicants must complete a Free ApplicationFor Federal Aid (FAFSA) no later than MARCH 15th - you must list the University of Iowa as acollege choice on the FAFSA in order for us to receive the information once you file the FAFSA.The FAFSA may be obtained from your high school counselor or you may file electrically afterJanuary 1st at : www.fafsa.ed.gov/.

�� You must submit a signed and dated copy of your parent(s) FEDERAL INCOME TAX RETURN andall supporting schedules INCLUDING schedule F, Farm and Income Expenses, by April 1st.

�� You must submit a signed and dated copy of your own FEDERAL INCOME TAX RETURN, if youfiled (ALL Tax returns must be for the current APRIL filing period each year).

�� If chosen to receive this scholarship, the sponsor may desire to contact you for publicitypurposes. Your signature below will allow us to forward your name and address to the sponsor.

Part III PUBLICITY RELEASE

Release of Information

I hereby authorize the Financial Aid Office to release my name and home address to the National Iowa Varsity Club for publicity purposes only.

______________________________________________ Date: _______________________

Be sure to complete Parts I, II, III of this application - Incomplete applications will not beconsidered!