EmailMe Form - ANA Gerome Walton Memorial Scholarship

ANA Gerome Walton Memorial Scholarship

The following questions are designed to collect information about your background, your interests and your future plans. Your answers to these questions will be used only in connection with your application for this scholarship program and will be divulged only to qualified people who must see them in the course of their duties. The selection of a scholarship recipient will be influenced by the completeness of replies and the neatness of the presentation.

Section 1:(Biographical Information)
You- The Applicant:
Name *
First Middle Last
ANA member number *
Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
Date of Birth *
MM / DD / YYYY
High School Now Attending *
Email *
Your Family
Father's Name *
Mother's Name
Guardian's Name, if other than mother or father
Brothers: Number, Ages
Sisters: Number, Ages
Section 2: (Education)
List in chronological order all schools attended in the last four years, include any summer or special courses.
List in chronological order all schools attended in the last four years, include any summer or special courses.
Please include the name of the school; the city and state in which it is located; and the dates attended
To what institutions of higher learning have you applied? *
Have any of your applications been accepted? Yes or No?

If yes, which school(s)? *
Which school do you plan to attend? *
Estimate your tuition and expenses for one year *
List other scholarships or assistance programs that you have applied for: *
Please include the name, location and amount you have applied for
What is your area of concentration in high school? *
What are your plans for a major course of study? *
Have you made any decision as to your future occupation? Yes or no?

If yes, please specify. *
Section 3: (ANA Involvement)
Tell us how long you have been involved with the American Numismatic Association and in what capacity. List any awards/scholarships you have received through the American Numismatic Association directly or through an ANA affiliated local club. *
Section 4: (Numismatic Interests)
Tell us what your collecting interests and goals involve. *
Section 5: (Involvement and Leadership)
Tell us about clubs or activities such as school, church, Scouts, 4-H, etc. of which you are a member. Include any offices you held and the year(s): *
Which of these activities have given you the greatest personal satisfaction? Why? *
Section 6: (Finances)
How do you expect to finance your college education? *
Why do you need scholarship aid? *
Estimated date of high school graduation? *
MM / DD / YYYY
An official transcript of your high school grades must be received by the Scholarship Committee in order to process your application.

Signature *
Clear
Please have sealed transcripts sent to:
ANA College Scholarship Committee
c/o Rod Gillis
818 N. Cascade Avenue
Colorado Springs, CO 80903
Date *
MM / DD / YYYY
Privacy Policy Agreement and Age Verification *
I agree with this website's privacy policy
I certify that I am at least 16 years of age

Section 1:(Biographical Information)

Your Family

Section 2: (Education)

Section 3: (ANA Involvement)

Section 4: (Numismatic Interests)

Section 5: (Involvement and Leadership)

Section 6: (Finances)