The Great Eighteenth The Eighteenth Masonic District Association Serving the "Great Eighteenth District" Scholarship Program Application Form PLEASE RETURN NO LATER THAN MARCH 1 NO EXCEPTIONS TO Dave Walters, Scholarship Chairman 105 Main Street Powhatan Point, Ohio 43942
18th MASONIC DISTRICT SCHOLARSHIP For your Application to be considered you must meet the following conditions. 1. Application must be received by the Chairman of the Scholarship Committee no later than MARCH 1, NO EXCEPTIONS. 2. Applications must be the Son, Daughter or Grandchild of a Mason in good standing of a Masonic Lodge in the 18th Masonic District, and a High School Senior Pursuing A Bachelor Or Associate Degree. Applicants Masonic Affiliation must be from any of the following 18th District Lodges listed below: NOBLE COUNTY: Sharon Lodge #136 - Sharon, OH MONROE COUNTY: Monroe Lodge #189 - Woodsfield, OH Sunsbury Lodge #362 - Beallsville, OH Clarington Lodge -597 - Clarington, OH MUSKINGUM COUNTY: Amity Lodge #5 - Zanesville, OH Dresden Lodge #103 - Dresden, OH Irville Lodge #184 - Nashport, OH Anchor Lodge #283 - Duncan Falls, OH Gage & Gavel #448 - Chandlersville, OH Olive Lodge #210 - Mt. Ephraim, OH Stafford Lodge #300 - Stafford, OH Masterton Lodge # 429 - Lebanon, OH LaFayette Lodge #79 -Zanesville, OH Malta Lodge #118 - Norwich, OH Hubbard Lodge #220 - Adamsville, OH Muskingum Lodge #368 - Fultonham, OH 3. Application must be complete and contain the following information: A. Must be signed by a Parent or Guardian. B. Must contain a Transcript. C. Must have Two Letters of recommendation excluding Family Members. Page 1
Scholarship Application Eighteenth Masonic District Scholarship Program Fill Out Completely: Applicant must be the son, daughter, or grandchild of a Mason Application must be typewritten: 1. Student Information: Name: Address: Birthdates: _ School District: High School: School Address: 2. Parent Information: Grandfather: Father's Name: Lodge name & number: Place of Employment: Position: Work Address: Phone: Home Address: Phone: Mother's Name: Place of Employment: Position: Work Address: Phone: Home Address: Phone: Number of dependent children in family: Page 2
3. Information Related to Post High School Education 1. What college or educational institution do you wish to attend? 2. Have you been accepted by this institution? 3. What type of degree are you going to obtain? Associate Bachelor 4. What is your area of interest? 5. What is the anticipated annual cost for your educational program per year? 6. Other scholarships applied for: 7. Have you been awarded any scholarship money? Yes No 8. Why do you feel that you have a need for this scholarship? Page 3
Student Name: High School Principal or Counselor completes this section: ATTACH TRANSCRIPT OF APPLICANTS GRADES SIGNED BY SCHOOL OFFICIAL 9. Number in Senior class: Girls: Boys: Applicants Class Rank: Junior Year: Senior Year: 10. Cumulative grade points average: (on a 4.0 scale) 11. SAT Scores: Verbal: Math: Total: Rate this score: high average low 12. ACT Scores: Rate this score: high average low 13. List any academic honors this student has received: (Possible Points -10) 14. Evaluation of the applicant: (Leadership, Perservance, Predication of success at university, Post high school education. (Possible Points -10) Signed: Position: Date: Page 4
Student Name: Please attach with this application recommendation statements from two persons, excluding family members. Name of reference: 1. Name: Relationship to applicant: Address: Telephone: 2. Name: Relationship to applicant: Address: Telephone: Statement of Applicant and Parent or Guardian: We have examined this application and the records are true, complete and accurate. Signed: Date: (Applicant) Signed: Date: (Parent or Guardian) Page 5
Student Name: Scholastic Record: Student completes this section: 1. Personal Achievement: (School Activates) (Possible Points -20) List the activities participated in during your high school attendance such as: Class officer, plays, athletics, music, organizations belonged to, offices held, etc... Activity No. of Years Remarks/Type of work 2. Describe your educational goals and plans for your future: (Possible Points -10) Page 6
3. List all other activities which will more fully describe your past achievements including out-of-school clubs and organizations: (Possible Points-10) 4. Is there any other information which you might consider important? Write an essay to be used as a tie-breaker. (Possible Points -10) Use additional sheets if necessary Page 7