Student Name_______________________________________________

Parent/Guardian Name _______________________________________

Street Address_______________________________________________

City ______________________________ Zip______________________

School Attending _____________________________________________

Grade Completed _____________________

(Please send this application for a $250 scholarship along with your registration to:
Dr. Trudie A Myers, Director
228 East Lake Drive
Estelline, SD 57234

Please tell the contributors of the scholarship the importance of science to you and how you hope it will help you in the
future.