Lodge of the Craft Westminster No Scholarship Application

Transcription

1 Lodge of the Craft Westminster No. 433 Scholarship Application This is a highly competitive grant program and cannot be given to all who apply. Please type application, or print in ink. Do not use pencil. Incomplete applications will not be considered. Personal Data Name: _ Telephone Number: Street Address: City, State, Zip: County: Social Security Number: Date of Birth: (mm/dd/yyyy): / / Age: Male/Female: If not currently, have you ever been a resident of Pennsylvania?: Yes No If answer is yes, for how many years: Have you ever been, or currently being, prosecuted or convicted of a crime? Yes No If yes, ATTACH A STATEMENT of explanation: (check if attached) Eligibility To be eligible to receive a scholarship from Lodge of the Craft Westminster No. 433, an applicant must be a child, step-child, grandchild, sibling, or dependant,(irs definition), of a member in good standing of a Pennsylvania Masonic Lodge in the 26th Masonic District, (or who was in good standing at the time of his death), or a present or former member in good standing in one of the Pennsylvania Masonic related youth groups, (please note that membership in other Masonic bodies in Pennsylvania is irrelevant). Applicant must be a High School Graduate, a High School Senior who is pursuing a College education, or

2 a current College student who meets the criteria to receive this grant. This grant is only applicable to undergraduate tuition and fees. Name of Masonic Relative: Member of which PA Lodge (Name): Lodge No.: District No.: Relationship to Masonic Relative: Check here if you re relative is a deceased Pennsylvania Mason: Are you currently a member in good standing in a Masonic related youth group: Yes No ATTACHMENT REQUIRED: Check here when attached. Letter of certification from the Lodge Secretary or Worshipful Master of the Lodge of your Masonic relative, in good standing, or your Masonic related youth group leader, certifying eligibility to receive a scholarship. THIS IS NOT A LETTER OF REFERENCE. IT ONLY VERIFIES THAT YOU ARE ELIGIBLE UNDER THE ESSTABLISHED CRITERIA. If you cannot append such a letter, include a separate written statement explaining why you cannot do this. YOUR ACADEMIC RECORD Name of High School Attended: Street Address: City, State, Zip: Phone Number: Year Graduated: or present Class Status: Class Rank: No. of Students. Check if Appropriate: Valedictorian Salutatorian

3 Name of College, University, Business, or Trade School: Street Address: City, State, Zip: Phone Number: Check one: I am currently attending I am planning to attend Current Student Status at College: (check one) Full Time Part Time Enrolled for next year Class in which you will be enrolled: Freshman Sophomore Junior Senior Major Course of Study: Minor Course of Study: Do you anticipate transferring or attending a different post secondary school than the one listed above? Yes No If yes, list name of post secondary school: GRADE POINT AVERAGE: Please provide your cumulative grade point average for your last COMPLETED academic year ( as of June): (For example: if you are a High School Senior, provide the G.P.A. from your Junior Year.) This MUST be evidenced by transcripts enclosed. PLEASE CIRCLE THE G.P.A. or equivalent on the transcript. G.P.A.: on a scale of. NOTE: Must equal or exceed 3.0 on a 4 point scale (75%) S.A.T. SCORES: MATH VERBAL If not available, please explain why: Is the National Honor Society available at your school? Yes No (check one) Are you a member of the National Honor Society? Yes No (check one)

4 If you hold an office in the National Honor Society list it here: List other academic honor societies and academic school clubs in which you hold membership: (non academic clubs are to be included in the Other Activities Section): List other academic honors and awards received: Please state your primary educational and lifetime goals, in your own words, in paragraph form, using 50 to 100 words: ATTACHMENT REQUIRED: Check here when attached. Original transcript or certified school copy of your most recent completed academic year. (High school or college). If you are in your first year of college, please ALSO include a transcript of your first semester s grades. PLEASE CIRCLE THE G.P.A. or equivalent on the transcript.

5 YOUR FINANCIAL NEEDS Do not any question blank. If financial information is not available, provide a reasonable estimate. Educational Expenses (per year): Tuition and Fees: Transportation: Room and Board: Other Expenses: $ $ $ $ Explain other expenses: Books / Supplies TOTAL EXPENSE: $ $ How much will you contribute toward your expenses? From Savings and Investments: By working during Summer: By working during School year: $ $ $ How much will your parent(s)/legal guardian(s) contribute? $ List financial aid from Scholarships and Grants, not loans, which you have been approved to receive for the next academic term: Total income from other Scholarships and Grants: $ List any other expected sources of Grant assistance or Loans: Estimated Expected Total: $

6 List names of dependent children in the family who are CURRENTLY ENROLLED in a post secondary school. NAMES SCHOOL ATTENDING ATTACHMENT REQUIRED: Check here when attached. In order to receive consideration you MUST attach a copy of pages 1 and 2 of your most recently completed U.S. Individual Income Tax Return (Form 1040, 1040A, 1040 EZ, or other I.R.S. filing forms), and, if you are claimed by them as a dependent, then that of your parent(s) or guardian(s). (All information will be held confidential, for the exclusive use of the Educational Scholarship Committee, and will be destroyed at the conclusion of the selection process ). You may ATTACH A STATEMENT providing any additional explanation of your financial need which you feel might help the committee understand you current need. Check here if attached. Your Fraternal Activities Are you ( the applicant) a Mason? Yes No If yes, of which Lodge?: Lodge Name: Lodge No.: District: Are you now, or were you, upon reaching your majority, a member in good standing of: (check one) DeMolay Rainbow for Girls Job s Daughters Group Name: Assembly/Chapter No.: Location: Have you served as a Presiding Officer? Yes No

7 Have you served as a State Officer? Yes No Explain: You may ATTACH A STATEMENT providing additional details of your Fraternal activities, honors, awards, or citations received. (check if attached) Your Other Activities List membership in non academic clubs, civic activities, community, political and religious organizations: Club / Organization Office Held/Rank/Honor or Award Received You may ATTACH A STATEMENT providing any additional details of Your Other Activities: (check here if attached) Certification I certify that all information contained herein, or attached, is correct to the best of my knowledge. Signature of Applicant: Date: How did you learn about this scholarship program? (Circle number of all that apply): 1. Masonic Scholarship Resource Guide 2. The Pennsylvania Freemason Magazine 3. Masonic Youth Group Leader 4. School Guidance Counselor 5. Parents 6. Grandparents 7. Other: Approved: Revised: 03 Feb A.D A. L. 6009

8 INSTRUCTIONS Applications must be postmarked no later than May 1st Remove this page before submitting Application This is a highly competitive grant program and cannot be given to all who apply. Please type applications, or print in ink. Do not use pencil. Incomplete applications will not be considered. Applications WILL NOT BE CONSIDERED without each of these items: 1. All pages of this application, with complete information. Be sure to sign and date the application on the last page. 2. Original transcript or certified school copy of your most recent completed academic year. (High School or College.) If you are in your first year of college please include a transcript of your first semester s grades. 3. Copy of pages 1 and 2 of your most recent U.S. Individual Income Tax Return, (Form 1040, 1040A, 1040 EZ, or other I.R.S. filing forms). ALSO, a copy of the same I.R.S. Tax Forms, from your parent(s), or guardian(s), if you are claimed by them as a legal dependent. If the current year return has not yet been filed, a copy of the immediate preceding year s return will be sufficient. PLEASE DO NOT SEND accompanying tax schedules. They are NOT necessary. 4. Letter of certification from the Lodge Secretary or Worshipful Master of the Lodge of your Masonic Relative, or your Masonic related youth group leader, certifying eligibility to receive a scholarship. THIS IS NOT A LETTER OF REFERENCE. IT ONLY VERIFIES THAT YOU ARE ELIGIBLE UNDER THE ESTABLISHED CRITERIA. If you cannot append such a letter, include a separate written statement explaining why you cannot do this. 5. Pages containing the completion of any answers in this application, and any additional information you would like to the committee to consider. We appreciate your interest in the scholarship program. It is a competitive program with a limited number of awards granted to those who meet the necessary criteria, and properly complete the application. PLEASE FOLLOW ALL INSTRUCTIONS. As a courtesy, all applicants will be notified by mail prior to June 1st, whether or not a scholarship will be awarded to them. MAIL COMPLETED APPLICATIONS NO LATER THAN MAY 1ST TO: Lodge of the Craft Westminster No. 433 P.O. Box 125 New Castle, PA