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LAWRENCEBURG PIERIAN WOMAN’S CLUB SCHOLARSHIP

Application for 2016Graduates DEADLINE: MARCH 31, 2016_____

1.Applicant’s Name:______

Last FirstMI

Address: ______

Phone: Home: ______Cell: ______Email______

Date of Birth: _____/_____/______SS#: ______

Graduated from ______High School

2.Applicant’s choice of college, university or technical school for the

2016-17 academic year (to which your scholarship check will be mailed):

Name of Institution

FullAddress:______

*MANDATORY: Office, Address, and Person responsible for collection of scholarship monies at this institution (email your college for this information):

College education level for 2016-17 school year: ______(Fr., Soph., Jr., or Sr.) Student ID #: ______

3.Family Information:

Father’s Name: ______

Address: ______

PhoneHome: ______Cell ______Email______

Occupation: ______

Mother’s Name: ______

Address: ______

Phone: Home: ______Cell ______Email______

Occupation: ______

Number in Applicant’s household (living there full-time)______

Number of household currently in college: ______

4.Financial needs for next academic year:

Tuition:$______Books:$______Housing:$______Food:$______

Total: $______

  1. Applicant’s proposed major, profession, vocation:______
  1. Please attach, separately, each of the following in the orderlisted:
  1. Officialschool transcript (mandatory) and latest (only)SAT/ACT scores, unless on transcript.Ms. Miracle will provide these for each application after they are handed in to guidance office.
  1. List of any special recognitions, honors, received by you; significant extra-curricular clubs (no abbreviations), sports, or other school-related activities and offices held; community service (list places and person in charge); and jobs (part/full-time) and employer’s name.
  1. List of scholarships already received or expected to be received, of any kind or from any source, along with the amount of each.
  1. A letter of recommendationfrom a non-relative who knows you outside school. Ask that they address your readiness to succeed in college and in your proposed major.
  1. A one-page (TYPED, 12 pt. font) essay, with your name at top right. This is the place to expand on areas this application addresses which will enhance our knowledge of you and/or a way for you to add information either not covered in this application form or that you feel is not covered to your satisfaction.

10.Have you ever received a scholarship from Lawrenceburg Pierian Woman’s Club before? ______If so, when? ______(You may apply as a college student again.)

11. All information in this application is confidential and seen by the Club Scholarship Committee only. Only winning recipients’ applications will be kept for our records, with vulnerable information blacked out; all others will be shredded.

12. The information above is true and correct to the best of my knowledge:

______

(Signature)Date

*(Please follow directions carefully. Incomplete or out of order application packets will NOT be considered.)