MARLTON ELKS LODGE #2514 SCHOLARSHIP APPLICATION FORM 2016

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1 MARLTON ELKS LODGE #2514 SCHOLARSHIP APPLICATION FORM 2016 Eligibility 1. Any son, daughter, step-son or step-daughter of a Marlton Lodge #2514 Elk who has been a member in good standing for at least one year is eligible to apply for this Award. 2. The applicant must be a college freshman, college sophomore, or college junior, and a full-time student at a two or four year college/university. (Taking at least 12 credits per semester.) The amount and number of awards will be based on the total number of applications received. Part I: To be completed by the Elk Parent with the longest continuous membership. Name: Spouse: Home Address: Your Membership Number: How long have you been an Elk? Relationship to Student: Father Step-Father Mother Step-Mother How many children live in your household? List their Names and Ages: By signing, I understand that the decisions of the Marlton Elks Lodge #2514 Selection Committee will be final. I verify that all the above statements are true: parent s signature Date:

2 Part II: Personal Information Page 2 1. The Applicant Name: Last First Middle Initial Mailing Address: City, State, Zip: Phone: ( ) - Address (required): Date of Birth (month-date-year): Age: Gender: Male Female 2. Citizenship Are you currently an American Citizen? Yes No NOTE: (Legal permanent resident status does NOT qualify. Applicant MUST be a citizen on the date the application is signed. 3. Education Year in School: College Freshman College Sophomore College Junior Name of College: College Address:

3 Page 3 Please read the following paragraph completely. This questionnaire is designed to collect information about your background, your interests, and your career plans. Your answers to these questions are confidential and will be reviewed by an independent scholarship selection committee. The selection of scholarship recipients will be influenced by the completeness of replies, neatness, and legibility. Please limit your responses to the space provided (i.e. Do NOT attach a separate piece of paper except for part 7). The past year will refer to January 1, 2015 to December 31, Please type or print neatly. 4. Leadership Section Honors and Awards Please list any scholastic, extracurricular, or civic honors and awards that you have received over the past year Activities and Organizations Please list all scholastic, extracurricular, and civic organizations that you participated in over the past year

4 Page 4 Offices and Positions of Leadership State the name of the organization(s) and office(s) that you have held over the past year Your Work Experience. List chronologically the jobs you have held over the past year. Include baby-sitting and work on a family farm or business. Type of Work Name of Employer Dates of Employment Total Hours

5 Page 5 6. Your Service to the Community List any volunteer work or community service you performed without pay over the past year. Type of Work Name of Agency or Organization Dates of Participation Total Hrs. or Service

6 Page 6 7. Your Current and Future Plans On an attached sheet in 300 words or less (limit to no more than one typed page, double spaced), describe your present educational goals, fields of interest, and career aspirations. Then sign and date it. By signing, I understand that the decisions of the Marlton Elks Lodge #2514 Selection Committee will be final. I verify that all the above statements are true: student s signature Date: NOTE: Please return the following by April 1, 2016, to the Marlton Elks Lodge #2514: Attention: John A. Roberts Jr., Scholarship Chairman, a) this completed application. b) your one page sheet (300 words or less ) describing your goals, interests, and aspirations signed and dated. c) a college transcript showing all course grades taken in previous semesters and your cumulative GPA.

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