Scholarship Application

All questions must be answered.

Name:_______________________________________________Birthdate:______________

e-mail:______________________________Telephone:______________________________

Permanent Home Address:_____________________________________________________

City: _______________________________ State: __________ Zip: ___________________

College Attending:____________________________________________________________

Address of College:___________________________________________________________

City: _______________________________ State: __________ Zip: ___________________

Cumulative Grade Point Average _________ ACT Composite _______ SAT __________

Standing in graduating class _____of_______

Expected Graduation/Certification Date: ___________________________________________

The following must be included as attachments to the application form:

An essay of no more than two (2) pages that will provide the scholarship committee with a “snapshot” of your life. It may include but is not limited to a description of your academic achievements, academic/career plans, extracurricular and community activities, awards and other recognition you have received, and your reasons for applying for this scholarship.
Three (3) letters of reference from three persons not related to you.
An official transcript.

By signing this application, I affirm that information contained herein is correct to the best of my knowledge. I grant permission to the Richmond Lions Club Scholarship Committee to verify all information and contact any of the provided references.

The application must be returned to the Richmond Lions Club, P.O Box 931, Richmond, KY.

__________________________________________ ____________________

Applicant signature Date

Application Deadline: March 15.