MIDLAND DOWNTOWN LIONS CLUB **Deadline
SCHOLARSHIP APPLICATION March 1st
(Application also available on website – www.downtownlionsclub.org)
NAME ____________________________________________________ HIGH SCHOOL __________________
ADDRESS __________________________________________________ PHONE ________________________
EMAIL ADDRESS____________________________________________________________________________
PARENT/GUARDIAN NAME(S) _________________________________________________________________
Academic and Community Achievements /Service
Grade Point Average ___________ Class Rank ___________
Extracurricular Activities and School Related Honors – List years, letters earned, offices held, medals/trophies earned in competition, etc. (Attachments are acceptable)
__________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Community Service/Honors – Church activities, Scouting, Teen Court, Casa de Amigos volunteer,
hospital volunteer, etc. (Attachments are acceptable)
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Collegiate and Career Plans
Colleges of Choice: 1) _______________________________________________________________________
2) ________________________________________________________________________
3) ________________________________________________________________________
Planned Major and Career Plans _______________________________________________________________
__________________________________________________________________________________________
Employment Information
Employer’s Name, Address and Phone __________________________________________________________
__________________________________________________________________________________________
Duties ____________________________________________________________________________________
Beginning Date of Employment ________________________ Hours worked per week _______________
Ending Date of Employment ___________________________
In 100 words or less, answer the following: Why Should I Be Awarded This Scholarship?
(Attachments are acceptable)
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
References – Provide name, phone number and email address (home address if no email address)
__________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________
Are you related to a current Lions Club member? ___ No ___ Yes Name _____________________________
Relationship ________________________
I certify that I have given you all relevant facts and information; that I have been truthful in this application; that I will notify you promptly of any change of the information given in this application; and
that I authorize you to contact any person or organization that you deem necessary to verify the information given in this application.
DATE _______________ _____________________________________________________ Student Signature
DATE _______________ _____________________________________________________
Parent/Guardian Signature
Return completed application to: Midland Downtown Lions Scholarship Committee
Must be postmarked by March 1st 200 Plaza St. Midland, TX 79701 (Revised 12-5-2012)
