This form is to be used in making application for scholarships offered by the Grand Rapids Grocery Manufacturer's Representatives.  Applications must be received by June 15th of the prior school year (i.e. 6/15/10 for fall 2010 enrollment).  Must be a full time student and possess a career interest in the RETAIL GROCERY INDUSTRY.  Notifications will be made in mid-August.

Last Name:   First Name:  Initial:   Age:

Home Address:   City:   State:   Zip:

School Address:   City:   State:   Zip:

Birth Date(xx/xx/xx): Daytime Phone: School Phone:  

Marital Status - Married, Single, Widowed, Divorced:  

Number of Children: Ages of children (if applicable):  

Father's Name: Occupation:  

Father's Address:   City:   State:

Mother's Name: Occupation:  

Mother's Address:   City:   State:

List all children of your parents including yourself first:

Name:

High School(s) Attended

  GPA:   City:   State:

  GPA:   City:   State:

Colleges or Universities Attended

  GPA:   Program of Study:   

  GPA:   Program of Study:   

  GPA:   Program of Study:   

List any other scholarships you will be receiving

Anticipated Personal Yearly Income    How much will be used for school? 

Special reasons you should be considered for this scholarship

Describe your ideal career position

What makes you interested in a career in this industry?

If you have a resume available, please forward a copy to jrkelly@hormel.com, referencing the date and approximate time of your application submission.

Scholarship recipients will be notified by September 1st.