Mesa Lodge No. 55, A. F. & A. M. APPLICATION FOR MESA MASONIC LODGE #55 BASIL T. KNIGHT SCHOLARSHIP And COLORADO MASONS BENEVOLENT FUND SCHOLARSHIP DIRECTIONS 1. Complete the Application 2. Include an Introductory Letter A. State why you need this scholarship B. What course of studies you wish to pursue 3. Provide at least three Letters of Recommendation These may include teachers, coaches, school administrators, church and civic leaders 4. Signed Statement of Applicant 5. Signed Statement of Parent or Guardian 6. Copy of transcripts and/or courses taken at a Colorado high school. 7. Completed FAFSA form by student s parents or guardian 8. Contact the Mesa 55, Masonic Lodge to arrange an interview 9. Submit the application to: Mesa Lodge No. 55, A. F. & A. M. The application and interviews must be completed by March 1 st Contact Persons Ronald P. Franklin 970-255-8047 rpfranklin@yahoo.com
APPLICATION FOR MESA MASONIC LODGE #55 BASIL T. KNIGHT SCHOLARSHIP Name Last First Middle Address Street City State Zip Telephone No. ( ) Cell Phone No. ( ) Date of Birth E-Mail Address Current High School Location Year Name of Institution of Higher Education you plan to attend Cumulative GPA Class Standing ACT/SAT Father's Name Mother's Name Occupation Occupation Employer Employer Have you earned anything by your own efforts in the past two years? yes no State ways of earning and how much Date of Interview Signature of Interviewers SCHOLARSHIP APPLICATION Page 1
Other children in family - names and ages: School activities, including offices held, membership in civic and church organizations and any other activities in which you participated that you feel are important. Indicate number of years in each activity. (Attach additional sheet if needed) SCHOLARSHIP APPLICATION Page 2
Other Scholarships/Grants/Financial Aid you have received. (what, where and amount received) Show the total $ amount in the appropriate space below. Did you submit a FAFSA application? Yes No (Include a copy with this application) Total anticipated resources for your freshman year From your family From your personal savings From earnings during your College year From loans From Work Study Programs From all other scholarships From grants listed above TOTAL RESOURCES Additional Documents needed with this application 1. An Introductory Letter 2. At least three Letters of Recommendation 3. High School Transcripts 4. Copy of your parent s FAFSA form Submit the application to: Mesa Lodge No. 55, A. F. & A. M. The application and interviews must be completed by March 1st SCHOLARSHIP APPLICATION Page 3
STATEMENT of APPLICANT I hereby certify that, if I am awarded a scholarship: 1. I need this scholarship money to continue my education. 2. I will use the scholarship money only for the payment of legitimate educational expenses at the school in which I am enrolled. 3. I agree to keep Mesa #55 Masonic Lodge Scholarship Administrator advised of the current address and phone number of my residence during the school year and a permanent address and phone number for contact during the summer and vacations. 4. I agree to make the necessary arrangements for the registrar at the institution I attend to send a copy of my transcript to the Scholarship Administrator at the end of each quarter or semester. 5. I agree to inform the Scholarship Administrator of any financial assistance I may receive which is not listed on this application. I hereby acknowledge that the information submitted is true and correct, and I fully understand my obligations as stated herein. Signature Date STATEMENT of PARENT or GUARDIAN I,, have read the foregoing application and hereby state that it is with my knowledge that is applying for the Mesa #55, Basil T. Knight Masonic Scholarship to further his/her education at. Name of Institution Signature of Parent or Guardian Date SCHOLARSHIP APPLICATION Page 4