Poquoson Lions Club

Poquoson Lions Club

Scholarship Application for 2017

General Instructions

The Poquoson Lions Club is proud to offer four types of college scholarships to the graduating seniors of 2017. The first is the Errol Champagne Scholarship recognizing the applicant with an exemplary record of community service, balanced by academic excellence. The second is the Don Hirschberg Scholarship, which recognizes athletic excellence, but must be balanced by academic acumen. The third is the Leo Scholarship for those students who participated in the Poquoson High School Leo Club and present a solid record of community involvement and academic excellence. The fourth is the Lion Scholarship that is similar to the Leo Scholarship, but does not require participation in the Poquoson High School Leo Club. The number and size of Leo and Lion scholarships depends upon the charity funds available from the Lions Club.

Applicants should check the box below corresponding to the scholarship for which they wish to apply. The Errol Champagne and Don Hirschberg Scholarships require extra information. Any Leo Club member applying for a Champagne or Hirschberg Scholarship will automatically be considered for the Leo and Lion Scholarships. Everyone who applies will automatically be considered for a Lion Scholarship. However, only one scholarship will be awarded to any one applicant.

1.  Type or print the information on your application.

2.  Attach an official school or homeschool transcript and a 1-2 page resume.

3.  Attach one letter of recommendation from a high school teacher or someone who knows you both in and out of the classroom.

4.  Attaching additional sheets of information is permissible.

5.  Return completed application to the Guidance Office by close of business on Friday,

12 May 2017. (Scholarship applications will not be considered after this date).

Part A – Personal Data

1.  Name (first, middle, last)______

2.  Date of birth/Place______

3.  Citizenship______

4.  Home Address______

5.  Phone______

6.  Parent/guardian______

7.  Address (street, city)______

8.  Phone______

Applying for (check all applicable):

Errol Champagne Scholarship
Leo Scholarship / Don Hirschberg Scholarship
Lion Scholarship

Part B – Academic Record & Plans

1.  Number of years at Poquoson High School______(if applicable)

2.  Class rank ______of ______(if known) Grade point average

3.  Other high schools attended (name, location)

4.  Class rank ______of ______(if known) Grade point average

5.  College you plan to attend (name, location)

6.  Planned course of study (major)

Part C – Extra Curricular Activities

1.  List your activities, offices held and honors received.

2.  Have you ever been employed? If so, list employer’s name and address, dates of employment, and position(s) held.

Part D – Community Service

List your community service activities, positions held, and awards received.

Part E – Additional Information

Include any special information that will help the scholarship committee to judge your application.

Part F – Errol Champagne Scholarship

Attach one letter of recommendation from an individual that provided oversight/guidance during a significant portion of the community service that you performed during your time in high school.

Part G – Don Hirschberg Scholarship

Attach one letter of recommendation from a coach or a varsity or AAU sport you participated in.

Part H – Signatures

Student Date

Parent or Guardian Date

For further information, please visit www.poquosonlions.com/community.html

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