La Marque Lions Club Scholarship La Marque High School
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1 SCHOLARSHIP REQUIREMENTS I. Eligibility To be awarded to a graduating high school student who has been involved with community service organizations or has participated in a community service project. II. Application Procedure In order to apply, submit the following by the deadline listed below: Completed application form Counselor recommendation Three teacher recommendation forms Discipline and attendance report 200-word maximum essay describing a community/service project or organization you were involved in during your junior or senior year of high school III. Amount $1,000 to be awarded for the first semester freshman year of post secondary education. IV. Deadline Completed applications must be mailed by April 14, 2018, to: La Marque Lions Club Attn: Russ Gillaspia P.O. Box 9004 League City, TX V. Criteria for Selection Applicants will be judged on the basis of applicant s community service contributions and financial need. VI. Selection The Committee will make the final selection(s). VII. Notification Notification will be at the winning student s year-end awards assembly. VIII. Awarding of Scholarship Funds The award recipient must submit proof of registration of community/private College, university or institute of his/her choice to La Marque Lions Club by September 1 st, 2018, and the scholarship proceeds will be remitted directly to the college, university or institution. 1
2 SCHOLARSHIP APPLICATION General Information Name: Address: Student SS#: Student ID#: City: State: Zip: Phone Number: High School: Family Information ( ) I live with both parents. ( ) I live in a single parent household with my: ( ) Please explain if living with a guardian, grandparent or other living arrangements. If your parents are divorced, does your non-custodial parent contribute to your support? Comments: ( ) Yes ( ) No Number of residents in household: Number of siblings and ages residing with you: Number of siblings in college at the same time as you: College(s) they attend: Father/Guardian s Name: Age: Occupation: Place of Employment: Phone Number: Mother/Guardian s Name: Age: Occupation: Place of Employment: Phone Number: 2
3 SCHOLARSHIP APPLICATION Amount of financial assistance expected from parents, relatives or other sources: Description (Example: Uncle John) Dollar amount/per semester (Example: $25/per semester) List names of other scholarships or financial aid you have applied for and indicate the status of these applications. (i.e. pending, confirmed or rejected). Description Dollar Amount Status Other financial information you wish the committee to consider: 3
4 SCHOLARSHIP APPLICATION Extra Curricular Activities & Work Experience List all extracurricular activities, years of involvement and any office held. List all honors and awards received (additional pages may be attached). List your current work experience. Place of Employment Position Dates of Employment Future Plans of Study In the space provided, describe the course of study or major interest you plan to follow, your proposed occupation or profession and any other information you want to be considered. 4
5 COUNSELOR RECOMMENDATION Student Name: Student s SS#: Student s GPA: Class Rank: Date of Rank: Indicate the high school program to be completed. ( ) Regular program ( ) Recommended program ( ) Distinguished Achievement Program SAT Scores Verbal: Math: Date: ACT Composite Score: Date: Counselor s Signature Date 5
6 TEACHER RECOMMENDATION Student Name: Student s SS#: Teacher s Name: Subject area or relationship to student: Using the following scale, please rate this student in the following areas: 4 Excellent 3 Good 2 Average 1 Poor Utilization of his or her ability. Degree of intelligent curiosity displayed by the student. Degree of participation in classroom discussion. Ability and willingness to follow instructions. Attitude toward school. Consideration for other people. Dependability What are the words that come to your mind in describing this student? Comments: Teacher s Signature Date 6
7 REPORT OF DISCIPLINE OF ATTENDENCE Student Name: Student s SS#: This student ( ) does ( ) does not have a discipline record. He/she ( ) is not considered in good standing. If the student has had some discipline referrals, please comment. The student has been sent absent days and tardy times during this school year. Assistant Principal s Signature Date 7
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