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PRINT AND COMPLETE THIS APPLICATION. MAIL IT TO:    
Dino Sumerano, Lions Scholarship Committee, P.O. Box 494, Hurley, NY 12443
 
Hurley Lions Club Scholarship Application
 
Amount: Up to six $500 Scholarships Deadline: April 20th
 
The Hurley Lions Club was founded in 1955 becoming part of Lions Clubs International an international network of 1.3 million men and women in 200 countries and geographic areas who work together to answer the needs that challenge communities around the world.  Beginning in 1917 the association of Lions clubs has provided millions of people with the opportunity to give something back to their communities.
 
The Lions motto is “We Serve.” Lions participate in service activities emphasizing research into the causes and treatment of sight and hearing loss, diabetic education, drug awareness, and education programs. Lions work with the physically and mentally impaired, support environmental issues, community welfare, international understanding, and youth programs. We are looking for students who, in some way, emulate the motto of Lionism. How do you serve?
 
Scholarship Eligibility Requirements
1. Scholarships in the form of tuition grants-in-aid are available to high school graduates with C or better grades, who have committed to continue their education after graduation. Selection will be based on Financial Need and Community Service. The area of study to be pursued is not limited.

  2. Applications will be accepted from students attending Kingston High School, John A. Coleman Catholic High School and Onteora High School. Applicants who reside in the Town of Hurley will be given first priority before other Ulster County, New York residents.

 
PLEASE TYPE OR PRINT THE FOLLOWING INFORMATION

NAME: Last                                                                 First                                  Middle             SOCIAL SECURITY # 

                   

 
 
STREET (NOT P.O. BOX)                                                        CITY                                                            STATE                  COUNTY:
                                                                                                                  NY              Ulster
DATE OF BIRTH (mm/dd/yyyy)                                               TELEPHONE NO.                                  E-MAIL ADDRESS                       
 
PARENT/GUARDIAN NAME                                             OCCUPATION                                    EMPLOYER                                                                                                                                        
 
PARENT/GUARDIAN NAME                                             OCCUPATION                                    EMPLOYER                                                                                                                                        
 
SIBLINGS: (Indicate names, ages and which are currently attending college)
 
 
 
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 3. Applicants must be considered a full-time college student by the standards set by the institution in which the applicant is, or will be, enrolled.

 

4.  Type or print legibly and submit: (a) two letters of recommendation from educators or administrators which discuss the Applicant’s character and potential for success in achieving his/her educational and career goals and (b) a copy of the Applicant’s most recent academic transcript.  It is the Applicant’s responsibility to ensure that the letters of recommendation and transcript are provided by the application deadline.

 

5.   Applicants may be asked to attend an interview with the Scholarship Committee.

 

I certify that I am a resident of the Town/Village/City of: ________________________________________________

 

Work History

 

        Employer

Nature of Work

Dates employed

Hours per week

Hourly pay

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Volunteer History “How do you serve?”

 

Organization

Nature of Service

Date(s) of service

Hours per week

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of school you presently attend: ______________________________________________________________________________

 

Class standing ____ of _______ Weighted GPA: ____________

 

List all scholarships applied for

 

 

Name of Scholarship

Amount per year

Status: unknown, approved, denied

 

 

 

 

 

 

 

 

 

 

 

 

 

 

By order of preference, list all colleges and universities applied to

 

 

College or University Name

Estimated tuition

Status: unknown, approved, denied

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attach a written response to the following questions:

1.  Indicate your field of study and describe your career plans:

2.  Explain your need for financial assistance.

3. Do you have a physical or learning disability? Please describe.

 

Upon submission of this application, I hereby authorize the “Scholarship Committee” of the Hurley Lions Club to review copies of my high school transcripts for purposes of academic evaluation.   I understand that scholarship awards may only be paid to a college or university directly to reduce tuition.  Should the college notify the Hurley Lions Club that a student’s tuition has been totally paid, resulting in the Lions Club scholarship not being needed for tuition, the scholarship will be voided

I give permission for my name to be published by the Hurley Lions Club in media articles.

I certify that the information submitted above, and as attachments to this application, are true and accurate.   In addition, I have completed and attached the following:

____ Two letters of recommendation

____ Recent academic transcript

____ Response to the three questions above

 

 

__________________________________________ ____________________________________________

    Signature of Applicant                                                          Date               Signature of Parent/Guardian

 

By April 20, a fully COMPLETED application should be sent to: Dino Sumerano, Lions Scholarship Committee, P.O. Box 494, Hurley, NY 12443  Questions: E-mail Dino at: avasta1@verizon.net

 

Revised 2011

 

 

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