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ALF M. DEISZ MEMORIAL SCHOLARSHIP AWARD
APPLICATION
Date of Application _______________________________
Name_______________________________________________ Date of
Birth_____________
(Last)
(First) (Middle)
Address____________________________________________________________________
(Street)
(City)
(Zip)
Organization or
Activity
Leadership in and/or Contribution
1._______________________________________________________________________
2. _______________________________________________________________________
3._______________________________________________________________________
4. _______________________________________________________________________
5. _______________________________________________________________________
6._______________________________________________________________________
7._______________________________________________________________________
8._______________________________________________________________________
9.________________________________________________________________________
In an attached, typed statement of not more than 200 words, describe your
plans after high school and explain how they relate to your long-range goals.
Before forwarding your application by May 1, to the Regional Office of
Education, make certain the following items are included:
1. This application form.
2. Letter from a school official certifying your class standing.
3. At least two letters from sponsors of organizations to which you have
belonged and contributed.
4. An attached, typed statement of not more than 200 words as outlined
above.
5. Evidence of acceptance at a two or four year college or university.
6. Return the items requested by May 1 to:
DeKalb County ROE
245 W. Exchange St., Suite 2
Sycamore, IL 60178
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