Application Main Step 1 of 6 16% Than you for applying for the Thomas H. Lutsey-Waseda Farms Scholarship. When your form has been successfully submitted you will receive a confirmation email. This email will have the links to complete the additional requirements. Personal InformationName* First Middle Last Address* Street Address City State / Province / Region ZIP / Postal Code County* Cell Phone*Second PhoneDate of Birth* Month Day Year Email* Parent/Guardian InformationParent/Guardian's Name RelationshipChoose RelationshipFatherMotherStep FatherStep MotherLegal GuardianOtherParent/Guardian's Occupation Second Parent/Guardian's Name RelationshipChoose RelationshipFatherMotherStep FatherStep MotherLegal GuardianOtherSecond Parent/Guardian's Occupation Sibling InformationNames and ages of siblingsNumber of family members who will be in college next yearInclude yourself.12345678+ EducationHigh School* Graduation Year*Does your school offer agriculture or FFA classes* Yes No Unsure Did you participate* Yes No First Choice of College* Were You Accepted Yes No Pending Not Yet Applied Second Choice of College Were You Accepted Yes No Pending Not Yet Applied Are you pursuing an agriculture-related field in college?* Yes No Intended College Major* Work ExperienceEmployer Position Date Started Month Day Year Currently Employed Date Ended Month Day Year Job ResponsibilitiesMore Work Experience Add More Work Experience Employer Position Date Started Month Day Year Currently Employed Date Ended Month Day Year Job ResponsibilitiesMore Work Experience Add More Work Experience Employer Position Date Started Month Day Year Date Ended Month Day Year Job Responsibilities Reference InformationPlease indicate the names and email addresses of your references. These individuals will be contacted via email with details on how to provide a letter of recommendation on your behalf for this scholarship application.First Reference* First Reference's Email* Second Reference* Second Reference's Email* High School InformationPlease indicate the name and email address of an authorized high school official who can provide your high school transcripts and ACT/SAT scores. This individual will be contacted via email with details on how to provide these academic records on your behalf for this scholarship application.School Official's Name* School Official's Email* Additional InformationHow did you originally find out about this scholarship?* When your form has been successfully completed you will receive a confirmation email. I agree to send a copy of my first semester grades to show successful academic progress. I agree to inform the Thomas H. Lutsey-Waseda Farms Scholarship of any college changes, including major, school, academic failure, etc. I authorize the Thomas. H. Lutsey-Waseda Farms Scholarship to use the information I submit, including a picture I will supply if selected as a recipient, in a bio on the Thomas H. Lutsey-Waseda Farms Scholarship website, on social media and in other promotional activities. I authorize the release of any information relevant to my application for this scholarship, and I certify that all information given on this application is true and complete to the best of my knowledge. I also grant release of my high school transcript and other academic information to the Thomas H. Lutsey-Waseda Farms Scholarship. Student Signature:*I agree to send a copy of my first semester grades to show successful academic progress. I agree to inform the Thomas H. Lutsey-Waseda Farms Scholarship of any college changes, including major, school, academic failure, etc. I authorize the Thomas. H. Lutsey-Waseda Farms Scholarship to use the information I submit, including a picture I will supply if selected as a recipient, in a bio on the Thomas H. Lutsey-Waseda Farms Scholarship website, on social media and in other promotional activities. I authorize the release of any information relevant to my application for this scholarship, and I certify that all information given on this application is true and complete to the best of my knowledge. I also grant release of my high school transcript and other academic information to the Thomas H. Lutsey-Waseda Farms Scholarship. Student Signature: