Acacia Lodge #33 Masonic Scholarship

Acacia Lodge #33
Masonic Scholarship

Name:

Address:

Street

Must be post marked on or before April 1, 2015 Page 2

Phone:

City

State

Zip

Must be post marked on or before April 1, 2015 Page 2

Date of Birth

Place of Birth

Must be post marked on or before April 1, 2015 Page 2

Social Security Number

List all Public High Schools attended and Locations of each:

Must be post marked on or before April 1, 2015 Page 2

Graduation Year:

Cumulative GPA to date

Must be post marked on or before April 1, 2015 Page 2

High School Activities and Offices Held:

Must be post marked on or before April 1, 2015 Page 2

Acacia Lodge #33
Masonic Scholarship

Non-School Organizations and Offices Held

College you plan to attend for your Freshman year and address: _

Proposed Major or course of study:

Intended Vocation:

Father's name and address:

Mother's name and address:

Guardian's name and address (if applicable)

Must be post marked on or before April 1, 2015 Page 2

Acacia Lodge #33
Masonic Scholarship

Masonic Affiliation if any (**for informational purposes, not a requirement for a
scholarship)

Masonic Sponsor and relationship (not required, but recommended)

Lodge Location if known:

Are you now, or have you ever been a member of a Masonic youth organization?

Must be post marked on or before April 1, 2015 Page 2

__ DeMolay

Rainbow

__ Job's Daughters

Must be post marked on or before April 1, 2015 Page 2

Name and Location of Chapter

Please give us a short statement as to why you feel you need this scholarship and
how it will benefit you in your pursuit for a college education:

•

Must be post marked on or before April 1, 2015 Page 2

Acacia Lodge #33
Masonic Scholarship
STATEMENT OF APPLICANT

I hereby certify that I am in need of this scholarship in order to continue my
education. If I am granted the scholarship, I will use the proceeds to apply on the
payment of tuition and fees or other expenses at the school or college that I plan to
attend.

To this end I will agree to:

1. Inform Acacia Lodge #33 if I do not attend college or my college status
changes while attending college

2. The information submitted herein is complete and correct to the best of
my knowledge.

Date:

Applicants Signature:

------

Statement of Parent or Guardian

I have read the application, and I attest to the accuracy thereof to the best of my
knowledge. I understand that the applicant is applying for a MONT ANA
MASONIC SCHOLARSHIP, and I have no objection thereof.

Signature and relationship _

Please return to: Acacia Lodge #33

218 West Park

Anaconda, MT 59711

On or before April 1, 2015

Must be post marked on or before April 1, 2015 Page 2