SCHOLARSHIP APPLICATION FORM OUTSTANDING STUDENT AWARD PROGRAM SPONSORED BY THORTON F. McELROY LODGE No. 302 Federal Way, WA

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1 SCHOLARSHIP APPLICATION FORM OUTSTANDING STUDENT AWARD PROGRAM SPONSORED BY THORTON F. McELROY LODGE No. 302 Federal Way, WA of WA Thornton F. McElroy 302 Lodge: Number: F. & A.M. Rory Johnson Public School Chairman from your Lodge Phone # HOW TO FILL OUT THIS APPLICATION FORM This application form is to be filled out by you, the student. It must be completed and turned into the high school career counselor no later than January 26, Should the applicant need more room to answer a particular question, additional sheets of paper may be attached to this application form. Please make sure that each attached sheet bears your full name and that the question number and paragraph subject matter are clearly indicated. (This form can be filled out electronically, however, you must still print, sign and submit the completed form to the appropriate location). It is very important that all answers are legible. Typed applications are desirable, but not necessary. Neatly written or printed applications are acceptable. For questions 7 to 9, responses exceeding 100 words are downgraded. You should keep a copy of your application. Applicants receive local Lodge certificates of recognition, plaques and scholarships to attest to their excellence. All awards are made on the basis of points awarded for scholastic achievement, community service, citizenship, financial need and evaluation of written responses. 1

2 Gender bias extends only to attempting to identify the most outstanding male and most outstanding female student in each school. Awards and scholarships are made and distributed without regard to race, creed, nationality, relationships to members of any Masonic organization, or other extraneous factors. APPLICATION FORM Name of Applicant Last Name: First Name: Mid. Int l: Class in School: Sex: Contact Phone: Name of High School: Name of Parent or Guardian: Contact Address of Applicant Street or Box and Route: Town, State, and Zip Code: Select which one of the following scholarships you are applying for: A Public School Academic Scholarship. B Public School Vocational Scholarship. C Masonic Family Scholarship. (DeMolay, Job s Daughters, Rainbow Girls ) 1. Please list all of the significant school organizations or activities in which you have actively participated, except for sports or music programs, since you have been in high school: NAME OF ORGANIZATION OR ACTIVITY: # OF YEARS: 2 OFFICE(S)HELD:

3 2. List all of the significant sports or music programs you have actively participated in since you have been in high school: NAME OF SPORT/MUSIC PROGRAM # OF YEARS 3. List all of the significant community activities you have participated in, including ChurchSynagogue-Mosque-Temple and leadership roles in organizations like Boy Scouts, Girl Scouts, 4H, DeMolay, Rainbow for Girls, Job s Daughters, Search & Rescue) List all of the significant honors or awards which you have received in athletics or academics while in high school: YEAR AWARD AWARD YEAR 5. What is your Accumulated Grade Point Average? 6. List the classes in which you are enrolled this year. Please indicate if you are a 'running start' or advanced placement student. 7. In not over three sentences, please explain the subject area you plan to study after high school and describe how you think your chosen field will influence your future and that of the community as a whole. 3

4 8. In not over three sentences, please explain: if you are unable to work in your chosen field what alternative field you would like to pursue. 9. Please tell us (in 100 words or less) Why some Mason has made a difference in the culture of this country or your community? 10. A letter of recommendation from a teacher or advisor should be attached to the application The letter of recommendation should explain a) why you are likely to be a successful college student, b) why granting of this scholarship is particularly critical to your higher educational goals, c) Please attach a copy of your official transcript to your application. 4

5 I hereby certify that the information contained in this application is complete and correct to the best of my knowledge and agree that falsification of information will result in disqualification and/or loss of scholarship. Please check box to agree with above statement. By submitting this application I agree to allow Thornton F. McElroy Lodge No. 302 to publish my name and photo in the event that I am awarded a scholarship(s). Please check box to agree with above statement. (Signature of Applicant) Date 5