If you have received a scholarship, please complete this form in order that your check will be issued. You can download and print the form by clicking here.

Simpson County Historical Society Scholarship Questionnaire

Full Name: _________________________________________________________

Address: ___________________________________________________________

City, State, Zip: ______________________________________________________

Social Security Number: _______________________________________________

Student Number (if different from social): ________________________________

Name of School: _____________________________________________________

To the Attention of: __________________________________________________

Address of School (where check needs to be mailed): _______________________________

City, State, Zip: ______________________________________________________

Any additional information needed to send your check:

Date __________________-

Please Return to the Simpson County Historical Society in order that your scholarship check will be issued to the university or college.  You may mail to 206 N College St, Franklin, KY  42134, email to oldjail@comcast.net, or hand deliver.  PLEASE INCLUDE A COPY OF YOUR CLASS SCHEDULE TO VERIFY THAT YOU ARE ACTUALLY ENROLLED IN CLASSES.  For your second semester, we will only need the proof of class registration unless some of the above information has changed.