Darrick Hayman Chairman Scholarship Committee 219 Hemming Way Granite Falls, WA 98252 Public Schools Scholarships Serving all of Washington State 4970 Bridgeport Way W University Place, WA 98467 (844) 288-3531 (253) 442-2505 www.wa-masoniccharities.org 2015-2016 SCHOLARSHIP APPLICATION FORM OUTSTANDING STUDENT AWARD PROGRAM SPONSORED BY THE MOST WORSHIPFUL GRAND LODGE OF FREE AND ACCEPTED MASONS OF WASHINGTON King Solomon 60 WA Lodge: Number: F. & A.M. Thomas Crawford Public School Chairman from your Lodge 206-805-9876 Phone # HOW TO FILL OUT THIS APPLICATION FORM This application form is to be filled out by the student. It must be completed and turned in to the high school counselor or to the high school office no later than February 27, 2016. 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 the student's full name and that the question number and paragraph subject matter are clearly indicated. (This form can be filled out electronically (go to: http://www.wamasoniccharities.org/webhost/scholarships), however, you must still print 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. Each student should keep a copy of his or her application. Members of the Masonic Lodge nearest each high school should coordinate collecting applications from the high school. While Grand Lodge scholarships are awarded to the winners in state-wide competition, some applicants may receive local Lodge scholarships, certificates of recognition, plaques, and/or trophies to attest to their excellence, even if they are not recipients of Grand Lodge financial aid. All awards are made on the basis of points awarded for scholastic achievement, community service, citizenship, financial need and evaluation of written responses. 1
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:
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). 1 2 3 4 5 4. List all of the significant honors or awards which you have received in athletics or academics while in high school: Award AWARD YEAR 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 of study will influence your future and 3
that of the community as a whole? 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
11. Financial Need A. Circle the range for your parent s gross combined income: Above $180K $160-180K $140-160K $60-79K $80-90K $40-59K 12. Are there other dependent children living in your household? If so, how many and what are their ages? How many? Ages? List Ages: $120-140K $100-120K $20-39K Less than 20K b. Does the family have any large medical bills or other large debts? Please explain fully. c. Has your Mother or Father obtained a higher education degree, If so, What kind? 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 Washington Masonic Charities 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 Washington Masonic Charities invests in youth and education, provides comfort and support for seniors and those in need, and preserves and shares the Masonic heritage of Washington State 6