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Bethel Lions Scholarship Application 2011/2012              o


 

Contact Information
 
1. Name
 
 
2. Street Address
 
 
City, State ZIP Code
 
 
3. Home Phone
 
 
Cell Phone
 
 
4. E-Mail Address
 
 
5. Date of Birth
 
 
6. Parents Name(s)
 
 
7. Gender
  Male                             Femle
 

 

8.  School Currently Attending
 
School Name
 
 
Street Address
 
 
City, State ZIP Code
 
 
Anticipated Graduation Date
 
 

 

 

9.  Activities
 
List extra-curricular school activities and the year(s) in which you have participated.
 
Year
 Activity / Sport Description
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

10.  School / Community Awards and Honors
 
List school and/or community awards and honors received.
 
Year
 Award / Honor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 


11.  Employment History
 
List names of employers as well as dates of employment.
 
Employer / Title
 From MM/YY
 To MM/YY
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

12.  College / Summer Employment

 

Do you plan on employment while at college and/or during the summer? If so, please provide any available details.

 

 

 

 

 

 

 

 

13.  Siblings
 
List ages of siblings presently attending or planning to attend college in addition to dates of attendance.
 
Name
 Age
 From MM/YY
 To MM/YY
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

14.  Other  Scholarships, Fellowships or Grants
 
Do you presently hold, or have you applied for other scholarships, fellowships or grants, to assist in college or university training?
 
Sponsoring Organization
 Terms
 $ Amount
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

15.  College / University Choice
 
List names and addresses.
 
Preference
 Name
 Address
 Accepted
 Pending
 
1st Choice
 
 
 
 
 
2nd Choice
 
 
 
 
 
3rd Choice
 
 
 
 
 

 


16.  Future Goals

 

What are your goals beyond college? Please include a typed response on separate paper if necessary.

 

 

 

 

 

 

 

 

 

 

 

 

17.  Community / School Service

 

The Lions Scholarship is weighted toward community & school service. Give a brief autobiography of yourself and state why you feel you should be considered for this scholarship. Describe the type of community and school service you have performed and describe the kinds of interpersonal skills you used to carry out each service. A short essay is required here. Please include a typed response on separate paper if necessary.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.  Community / School Service References
 
Please supply contact information of person(s) who supervised your work in the area of community and/or school service.
 
Name
 Organization
 Contact Information
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 


19.  Personal Materials

 

Attach any personal materials that may be relevant to applying for this scholarship. (Newspaper articles, certificates, etc.)

 

 

20.  Signature
 
By submitting this application I, the undersigned, make this affirmation to the Bethel Lions Club that I reside in the Town of Bethel and all statements made in the application for this scholarship herein are true to the best of my knowledge and belief. I understand that any false statements, omissions, or other misrepresentations made by me on this application will result in my disqualification.
 
Name (printed)
 
 
Signature
 
 
Date
 
 

 

 

Bethel Lion’s Scholarship Application Guidelines

 

Please submit your responses typed directly into this form or legibly written on a copy of this form. Additional pages should be labeled with applicants name in the top left corner. Responses included on separate pages should be numbered consistent with this application. This form must be signed after completing and printing.

 

• A copy of your High School transcript must be submitted with this application along with a letter of recommendation from a guidance counselor or teacher.

 

• Complete applications must be returned to the guidance counselor’s office before the close of the school day on June 1, 2012.

 

• The Lions will ask you to report back to us during the summer following your freshman year, telling us a little bit more about yourself, your college experience and how you were able to use your scholarship money. Please contact Maria Frangipane at (845) 583-6540, no later than July 1, 2013 following your freshman year.

 

Eligibility

 

•    For full time residents of the Town of Bethel with an 85 grade point average or higher.

 

•    Applicant must be a High School graduate having attended one of the following High Schools: Monticello, Liberty or Sullivan West. Home schooled or private school graduates are also eligible.

 

Scholarship / Award

 

The Bethel Lions Club is offering $1,000.00 scholarships to Town of Bethel residents who will attend an accredited two or four year institution of higher learning September through May.

 

 

Criteria

 

Listed in order of weighted priority. However, from year to year, depending on the applications submitted, the selection committee may place a higher value on a particular criterion.

 

•    Academics

•    Service to Community & School

•    Character (Letter of reference from Guidance Counselor or a Teacher)

•    Extra-Curricular Activities

•    Need

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