Brisbane Lions Club

Scholastic Achievement Awards Application

Candidate Name: ______Date: ______

Criteria: Scholastic Achievement Record Grant/Awards: Range from $500 to $2,500

Desires and Goals (subject to change without notice)

Financial Need

Applicants must be current Brisbane residents for one year or longer - exceptions: living away at

schoolwith parent(s) or guardian living in Brisbane, or serving as a member of the U.S. military. Please confirmyoureligibility status by contacting the committee prior to submitting your application.

Application Procedure:

1. Deliver completed application including: Official Grades Transcript, and Reference Letters.

by April 11th to: Brisbane Lions Club

Scholastic Achievement Awards

P. O. Box 317

Brisbane, CA 94005 or all may be submitted via Email at:

Late submissions may be returned!

2. Answer questions by phone if requested, and if selected as a finalist: attend an interview, which

in case of students away at school may be conducted via conference call.

The Brisbane Lions Club serves our community in many ways. One of the most important is the support of education. Through the efforts of our members and the support of our community, we offer awards to those who are pursuing higher education. Last year we were able to direct $25,000 total to 23 deserving students. Please follow these guidelines to participate in this year’s awards.

Publication Release: Applicant, or parents if you are under age 18 authorize the

Brisbane Lions Club and its affiliates to use a full, partial, or

edited version of your essay responses, or photos which are taken,

in public at the award presentation.

You waive all rights to any compensation, or claims of any damages.

Award Presentation Dinner: May 27, 2014 7:30pm

All applicants selected are invited to be the guests of the Brisbane Lions Club for a Presentation of Awardsat the Brisbane Community Center. Applicants are guests of theBrisbane Lions Club. Awardswill be presented to all recipientsselected who are able to attend, or to a member of their family if the recipient is unavailable, and if no one is present to receive the Award, it will be mailed to you.

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Brisbane Lions Club

Scholastic Achievement Awards Application

GENERAL INFORMATION:

ApplicantName: ______

Address : ______

Phone : ______

Email : ______

School you currently attend: ______

Schools you have applied to for admission: ______

(if not already accepted or attending)

______

______

DESIRES & GOALS: ______

(attach additional pages if needed) ______

______

Major if declared: ______

Employment Experience: ______

(attach additional pages if needed)

______

Attach CV if you prefer: Yes [ ] No [ ]

Family information: ______

______

______

______

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Brisbane Lions Club

Scholastic Achievement Awards Application

Transcripts: Attached [ ] or To be forwarded by school [ ]

NOTE: 2-3 years transcripts are requested. If multiple schools, please include all.

College/University GPA: ______

High School GPA: ______

Test Scores: SAT: ______

If Available SAT II ______

ACT: ______

Graduate of:

High School: Year: ______

College/U: Year: ______

Trade if applicable: ______Year: ______

Degrees earned: ______Year: ______

______Year: ______

Honors received: ______Year: ______

Activities/Interests/Community Service:

Please give us a good understanding of who you in general beyond your scholastic achievements.

Attach your answers to this application, or as an

email attachment: ).

A. What event has most inspired you?

B. What do you plan to do with your life?

C. Why is it important for you to pursue your educational goals?

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Brisbane Lions Club

Scholastic Achievement Awards Application

FINANCIAL NEED:

EXPENSES: Please showyour anticipated expenses for the current year (next 12 months).

Tuition and fees

Room and board

Books and supplies

Other School fees (?)

Transportation

Any other (?)

Total Estimated Expenses: ..$______

INCOME: Please show what sources of income you anticipate for the current year (12 mos.)

including any grants or scholarships other than what may be awarded to you

by the Brisbane Lions Club.

Your primary source of funds are from: your job [ ], parents/savings [ ], or loans [ ]?

Parents

Personal savings

Current job/business

Grants

Scholarships

Loans

Total Estimated Income: ...$______

Are you the primary caretaker for a parent, child or other relatives? Yes [ ] No [ ]

If applicable: how does that responsibility impact your ability to attend school?

______

Reference Letters:

Please provide three (3)verifiable written recommendations. These may be hand written or email.

Reference sources: Teacher, Professor, Clergy, or other Mentor.

1. Name: ______Tel.: ______Occ.: ______

2. Name: ______Tel.: ______Occ.: ______

3. Name: ______Tel.: ______Occ.: ______

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