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Make Sure Your Application Is Complete:
3 Completed Application Form (2 Copies)
3 Transcript (7 Semesters, 2 Copies)
3 300-Word Essay (2 Copies)
3 Educator’s Statement (2 Copies)
3 Letter of Recommendation (2 Copies)
3 Sponsor Signature From NTCA Member
3 Postmark to FRS no Later Than March 1, 2017
Must have all items on checklist to be considered.
Please submit all materials together.
2017
College Scholarship Program
The Foundation for Rural Service (FRS), in cooperation with
NTCA–The Rural Broadband Association, seeks to sustain
and enhance the quality of life in America by advancing an
understanding of rural issues. Through its various programs
and initiatives, FRS strongly supports the continuing
education of rural youth.
Eligibility
Each applicant must:
Be a graduating high school senior.
Be a United States citizen.
Be sponsored by a current NTCA–The Rural Broadband
Association member.
1
Be accepted by an accredited two- or four-year college,
university or vocational-technical school.
Have at least a C grade point average (GPA).
Express an interest to return to a rural community
following graduation.
Application Instructions
Type (preferred) or print all requested information.
Complete the scholarship application in full. If any
information is incomplete, the application will be rejected.
Prepare a 300-word essay on one of the following
topics:
1. Describe your most significant accomplishment,
and explain why you believe it to be your most
outstanding.
2. Describe the community in which you live, and
indicate how it has influenced the person you are.
3. What industry or opportunity would entice you to
return to a rural community after completing your
education, and why?
The essay portion of the application is worth 35% of your
total score. Make sure to use spell-check and grammar-
check before submitting your essay.
Have a high school teacher or guidance counselor
complete the Educator’s Statement. Please ask the
author to provide two copies of his/her statement.
Submit one letter of recommendation from a local
community leader other than an educator (examples
include telephone company personnel, elected official,
local business leader, etc.). Please ask the author to
enclose two copies of his/her letter.
Include two copies of your transcripts, including the
most recent semester. Transcript does not have to be an
official copy.
Have the manager, or designated employee of your
sponsoring company endorse your application, and
thus commit to the NTCA member match requirement.
Unsigned applications will not be accepted for
consideration. Please check with your local NTCA
member to see what its requirements are for
sponsorships.
Do not include any photographs with your application.
All signatures must be provided where indicated on the
application.
All materials, including recommendation letters, must be
submitted together.
In 2017, FRS will award scholarships per geographic
region of the NTCA membership and one sponsored
by an NTCA associate member. The awards will be
distributed proportionate to the number of applications
received per region. FRS will fund $2,000 of each
scholarship, with the sponsoring organization of each
winning student providing a $500 match.
Four $5,000 Staurulakis Family Scholarships will be
awarded, with a preference to students who are majoring
in math, science, engineering or medicine.
Two $1,500 TMS scholarships will be awarded to
students.
One $7,000 Everett Kneece Return to Rural America
Scholarship will be awarded.
Terms and Conditions
All applications will be reviewed, and winners selected by
a qualified selection committee of educators.
Scholarships will be awarded on a one-time basis and
will not be renewable.
Awards will be paid upon proof of registration at an
institute of higher education and will be issued by
August 2017.
Scholarships will be awarded without regard to race,
ethnicity, national origin, religion, gender or disability.
Incomplete applications will not be considered. Refer to
the checklist on the application form to ensure that all
components of the application have been fulfilled.
Winners will forfeit their scholarship if mandatory
paperwork is not received by FRS within 60 days of
notification that they have won.
Winners will be posted on the FRS website, www.frs.org,
by May 1, 2017.
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Please contact your local telecommunications provider to determine if it is an NTCA–The Rural Broadband Association member or former FRED Donor Circle member
and if it is participating in the FRS College Scholarship Program. Sponsor company must be a current FRS donor of a minimum of $500 within the past 12 months, or a
former FRED Donor Circle member.
COLLEGE SCHOLARSHIP APPLICATION
This Page Is To Be Completed by One of Your Teachers or Your High School Guidance Counselor
To Be Submitted by Student With Completed Application.
*Teacher/Counselor: Please fill out, make one copy, and provide both copies to the student.
Applicant’s Name Date
High School
Teacher’s/Counselor’s Name
Position
Please describe whatever you think is important about this student, including a description of academic and
personal characteristics. We are particularly interested in a candidate’s intellectual promise, motivation, relative
maturity, commitments to service, integrity, special talents and enthusiasm, hardships overcome (if applicable)
and initiative. We welcome any information that will help distinguish this student from others. Please submit
your comments below. Attach additional page if necessary.
Personality & Character Evaluation
Compared with other high school seniors, how would you rate this student in the following areas?
AverageGoodVery Good
Excellent
(Top 10%)
One of the
Best That I
Have Ever
Encountered
Positive Attitude
Enthusiasm & Support
of the School
Respect for Others
Leadership Qualities
Academic Achievement
Sense of Responsibility
Principles and Values
Signature of Evaluator
Date
EDUCATOR’S STATEMENT
 
Name: First Middle Last
Email Address
Mailing Address
City State Zip
Telephone Number Gender Male Female
Name of Parent(s) or Guardian(s)
High School High School Telephone Number
Grade Point Average (please provide your unweighted GPA cumulative through your 7th semester)
SAT Score (if applicable) ACT Score (if applicable)
College, University or Vocational/Technical School You Plan to Attend
College, University or Vocational/Technical School Admissions Office Telephone Number
Have You Been Accepted? Yes No
Anticipated Major or Area of Study
(Students who are majoring in math, science, engineering or medicine will automatically be given
preference for the FRS Staurulakis Family Scholarships.)
Work Experience: List your work experience over the last four years, in chronological order, with your most
recent job listed first. Attach additional page if necessary.
School Activities: List all school activities in which you have participated in the last four years (i.e., athletics,
student government, clubs). Attach additional page if necessary.
Instructions:
1. Please fill out both sides of this application and
mail with all attachments and one photocopy of all
materials to:
2. Please type (preferred) or print all information in
black or blue ink. No pencil.
3. Include all requested attachments with application.
4. Postmark application to FRS no later than
March 1, 2017.
Selection Committee
Foundation for Rural Service
4121 Wilson Boulevard, Suite 1000
Arlington, VA 22203-1801
Activity
Years
(1, 2, 3, 4)
Average Hours
Per Week
Comments
Company Position/Job Description
Employed
From
Employed To
Average Hours
Per Week
COLLEGE SCHOLARSHIP APPLICATION
Madison
Rae
Keim
mkeim1998@yahoo.com
17151 West Lone Pine Drive
Queen City
MO
63561
660-341-9613
Kirksville High School
660-665-4631
3.184
Moberly Area Community College
Agriculture Education
Gliks
Sales Associate
April 2016
present
10
John's Seed & Supply
Greenhouse Assistant
Spring 2013
Spring 2015
10
Varsity Football & Basketball Cheerleader
1,2,3,4
15
Community and Volunteer Activities: List all nonpaid community activities in which you have participated in
the last four years (i.e., volunteer efforts, church work). Attach additional page if necessary.
Awards and Honors: List all awards and honors received in the last four years (including academic awards or
honors). Attach additional page if necessary.
Special Circumstances: Describe any additional information you feel the Selection Committee should
consider in the selection process (i.e., family need or hardships overcome). Please provide this information in
an attachment to this application, typed (preferred) or printed in blue or black ink. Do not answer this question
if you feel that there are no special circumstances or important facts to relay.
Submit essay as attachment: Essay should be approximately 300 words, typed (preferred) or printed,
12-point font, double-spaced with one-inch margins. Please address one of the following statements:
1. Describe your most significant accomplishment, and explain why you believe it to be your most outstanding.
2. Describe the community in which you live, and indicate how it has influenced the person you are.
3. What industry or opportunity would entice you to return to a rural community after completing your
education, and why?
Applicant Certification
I hereby certify that all of the information provided in this application is complete and true to the best of my
knowledge. I hereby grant permission to FRS to contact my references and/or school if necessary, and to use
my name and likeness in promotional materials in the event that I am selected to receive a scholarship award.
Signature of the Applicant Date
Activity (i.e., soup kitchen)
Years
(1, 2, 3, 4)
Average Hours
Per Week
Comments
Years
Award or Honor
(i.e., Eagle Scout Badge, National Merit Scholar)
Comments
(Describe the Honor – Why Given)
NTCA Member Sponsor Certification
By signing this form your company is committing to provide the $500
scholarship match required in the event that your applicant is selected
as a winner in the FRS scholarship program.
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NTCA Sponsoring Company Name
Signature of Sponsoring Manager Date
or Designated Employee
Printed Name of Sponsoring Manager or Designated Employee
Telephone Number
City State NTCA Region
Make Sure Your Application Is
Complete:
Completed Application Form (2 Copies)
Transcript (7 Semesters, 2 Copies)
300-Word Essay (2 Copies)
Educator’s Statement (2 Copies)
Letter of Recommendation (2 Copies)
Sponsor Signature From NTCA
Member
Postmark to FRS no Later Than
March 1, 2017
Must have all items on checklist to be
considered.
Please submit all materials together.
COLLEGE SCHOLARSHIP APPLICATION
1
Please contact your local telecommunications provider to determine if it is an NTCA–The Rural Broadband Association member or former FRED Donor Circle member and if it
is participating in the FRS College Scholarship Program. Sponsor company must be a current FRS donor of a minimum of $500 within the past 12 months, or a former FRED
Donor Circle member.
Mail your completed application, attachments
and additional copies of all materials to:
Selection Committee
Foundation for Rural Service
4121 Wilson Boulevard
Suite 1000
Arlington, VA 22203
All applications must be postmarked to FRS
no later than March 1, 2017.
Questions
If you have questions about locating an NTCA
member sponsor or FRED Donor Circle member,
please contact your local telecommunications
provider to see if it is a member of NTCA and
what its requirements are for sponsorship. FRS
cannot distribute a list of NTCA members.
If you have questions about the application form,
please contact FRS at foundation@frs.org.
www.frs.org