SCHOLARSHIP PROGRAM CHARLES GALE MASONIC MEMORIAL SCHOLARSHIP WILLIAM H. UPTON NAVAL AND MILITARY LODGE # / 2009 ACADEMIC YEAR

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1 SCHOLARSHIP PROGRAM CHARLES GALE MASONIC MEMORIAL SCHOLARSHIP General Information: Students applying for this scholarship must be enrolled as full time students at Olympic College, and must be entering their sophomore year of college study. One scholarship of $1,500 will be awarded annually. Scholarship Criteria/Eligibility: Applicants must be a United States Citizen and provide proof of Washington State residency. Applicants must have a cumulative college level grade point average of 3.0 or equivalent scholastic standing to qualify for the scholarship, and must maintain a minimum grade point average of 2.5 each quarter to remain eligible for this scholarship. Applicants must submit an official, sealed grade transcript through the last quarter of enrollment from all colleges and universities attended. Applicants must submit three original (not photocopied) letters of recommendation addressed to the Charles Gale Memorial Scholarship Committee. The letters must be from individuals that have intimate knowledge of an applicant s academic, personal, or professional background. Letters from academic references, employers, religious leaders, and Masonic friends or relatives are preferable. Applicants must submit a 100 word goal statement. Applicants should be prepared for a personal interview with members of the Charles Gale Memorial Scholarship Committee. Application Information: The attached application packet (with your permanent Washington address), official student transcript (in a sealed envelop), three letters of recommendation, and your personal goal statement must be received by the Charles Gale Masonic Memorial Scholarship Committee no later than May 16, Late and incomplete application packages will not be considered. Mail application packages to: Mr. R. L. Giard 4890 Estonia Court SE Port Orchard, WA 98367

2 THIS ENTIRE APPLICATION MUST BE TYPEWRITTEN Page 1 of 4 Applicant Name: (Last, First, Middle) Applicant Social Security Number: I declare that I am a United States Citizen and a bona fide resident of the state of Washington. I will provide a copy of my quarterly class schedule and grade report to the William H. Upton Masonic Lodge Scholarship Committee at the end of each term, and I understand that I must complete 12 credits of instruction with a minimum grade point average of 2.5 each quarter to remain eligible for this scholarship. Failure to complete the required credits or maintain the required grade point average may result in forfeiture of this scholarship award. Applicant s Signature Date Permanent Street Address: City: State: Zip Code: Telephone Number: Temporary Street Address (If different from permanent address): City: State: Zip Code: Temporary Telephone Number (If different from permanent address): Birthplace: Age: City State/Province Country Date of Birth: Marital Status (check one): Married: Single: Name and Address of parents, foster parents, or guardian (circle one) Father s Name: Father s Address: Mother s Name: Mother s Address:

3 CAREER and EDUCATION INFORMATION EMPLOYMENT HISTORY (Include all employment you have held since secondary school): Full/Part Employer Title/Position Time Dates Page 2 of 4 AWARDS (List all high school and collegiate awards that you have received. Include scholarships, fellowships, honors, commendations, and military awards): Award Reason for Award Date(s) EDUCATION (Provide a summary of academic, technical, and/or professional education beginning with high school. Include the school(s) that you are now attending): Name and Location of Educational Institution Dates Attended Degree or Diploma Date(s) List your Major area of study:

4 BENEVOLENCE, CITIZENSHIP, and REPUTATION List organizations of which you are, or have been a member: Page 3 of 4 Name of Organization Involvement with Organization Dates/Years Have you been, or are you a member of the United States Armed Services? YES NO If YES, what branch of Service? If no longer on active duty, list date and type of discharge: In addition to the above, list any social, athletic, political, community, church youth group, Masonic youth group, or other activities in which you have participated before, during, or after high school: Organization Type of Participation Dates List and explain any crimes for which you have been convicted:

5 Page 4 of 4 List the names of six references that have intimate knowledge of your academic, personal, or professional background. Have three of your listed references submit letters of recommendation addressed to the Charles Gale Masonic Memorial Scholarship Committee, and provided directly to you for inclusion in your application package. Only original letters, and letters addressed to the committee will be accepted. Letters from academic references, employers, religious leaders, and Masonic friends or relatives are preferable. Each letter should be from a different category. Name Address Telephone Relationship (Professor, Friend, etc.) In making application for a scholarship to the William H. Upton Lodge #206 Charles Gale Masonic Memorial Scholarship Committee, I do swear by my signature that I will support the Constitution and laws of the United States of America, and will by precept and example promote respect for the flag and the institutions of the United States of America. Signature of Applicant: Don t forget to attach a signed Goal Statement of 100 words or less