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.
 Activity / Sport Description


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


11.  Employment History
List names of employers as well as dates of employment.
Employer / Title
 From 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.
 From 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
 $ Amount


15.  College / University Choice
List names and addresses.
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.
 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)



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.




•    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.





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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