Order Sons of Italy in America
Lodge Scholarship
APPLICATION FOR SCHOLARSHIP
Applicant
Information
Name
__________________________________________ Sex ______
(last)
( first)
(middle)
Address
__________________________________________________
(number and street)
__________________________________________________________
(city)
(state)
(zip code)
Telephone Number
___________________ Date of Birth ____________
Social Security Number:
______________ Place of Birth ___________
Family Information Father's
Name ___________________ Occupation _________________ Place
of Employment ____________________ Annual Income ________ Mother's
Name ___________________ Occupation _________________ Place
of Employment _____________________ Annual Income _______ List
Names and Ages of Brothers and Sisters, Indicate if any are currently attending college.
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School Information Name of High School Attending
_________________________________ Date of Graduation
__________________________
List School Clubs,
Offices, and Activities you are involved in: ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Personal and
Community Interests and Hobbies List Community Organizations and
Activities in which you have been involved. ____________________________________________________________ ___________________________________________________________ ___________________________________________________________ What are your interests, hobbies,
pastimes, and leisure activities?
__________________________________________________________ ___________________________________________________________ ___________________________________________________________
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Work Experience List any work experience(s) and
indicate if you are currently employed. ___________________________________________________________ ___________________________________________________________ Colleges and
Universities List the colleges and universities
to which you have applied for admission. State if you have been accepted. 1._________________________________________________________ 2._________________________________________________________ 3._________________________________________________________ In what subjects do you plan to
Major and Minor? Major ______________________
Minor ______________________ Scholarships and
Financial Aid List any other financial aid and/or
scholarships you have already received or for which you are applying. 1._________________________________________________________ 2._________________________________________________________ 3._________________________________________________________ Italian Heritage Recipients of this scholarship must
be of Italian Descent. Explain how you qualify. __________________________________________________________ ___________________________________________________________ ___________________________________________________________ List all present or past family
members who are or have been members of the Order Sons of Italy in America. Include the
number and Lodge Name. (This is for Information only and is not a factor in the decision
making process.) ___________________________________________________________ ___________________________________________________________ |
Terms of
Application By my signature below, I certify
that I am of Italian Descent and intend to enroll as a full-time student in an accredited
Junior College, College, or University immediately upon graduation from High School.
I understand that any unused portion of this scholarship will be returned to the
Jacksonville Lodge Sons of Italy in America if I cease attending classes and/or withdraw
from school without immediately enrolling in another school. ______________________________________
________________
(Applicant's
Signature)
(Date) ______________________________________
________________
(Parent's
Signature) (Date) This Application must be completely
filled out. Incomplete submissions will not be considered or returned. Scholarship
winners will be notified. Please mail the
completed four (4) page application, check list, and all applicable supporting documents,
postmarked no later than March 31. |