2015 LPD SCHOLARSHIP APPLICATION
STATEMENT REGARDING APPLICANT
Combined school and extra-curricular activities will prove this student to be an overall outstanding citizen with an excellent work ethic. The selected candidate will personify the spirit and fortitude embodied by the Lunch Pail. Said candidate will have shown excellence in character by virtue of their commitment to community (best demonstrated via community service), diligence in academics (reflected in grades as compared to aptitude testing), participation in extracurricular activities (as articulated by teachers/coaches, etc), and resilience in the face of life’s adversities. Finally, the selected candidate will have shown a demonstrated financial need for the Lunch Pail Scholarship in so far as he/she has shown financial difficulties paying for college tuition, books, room and board.
ELIGIBILITY*
- 2.5 Minimum GPA (copy of high school transcript required)
- Official high school transcript (from a school located in the New River Valley or Roanoke Valley regions of Virginia) or official GED test scores
NOTE: WE ENCOURAGE ALL APPLICANTS TO SUMBIT THIS FREE APPLICATION EVEN IF THERE IS A QUESTION OR CONCERN REGARDING INELIGIBILTY DUE TO THE ‘GEOGRPAHICAL PROXIMITY’ REQUIRMENT NOTED ABOVE. IN SUM, WE WILL GIVE DUE CONSIDERATION TO ALL APPLICANTS.
APPLICATION REQUIREMENTS
- Completed Application Form
- Official SAT and/or ACT scores.
- Proof of college acceptance
-Official university or college transcripts if applicable
- Two (minimum) written references regarding the applicant’s history, background and character:
a) One reference must be a school related reference (e.g. teacher, counselor or coach); and,
b) One reference must be an external reference for extra-curricular activities outside of school (e.g. church, community service, or athletics.)
- Written statement from the applicant explaining why he/she is applying and how her/his character personifies the fortitude embodied by the Lunch Pail.
Mail completed form and all other required documents by February 28, 2015to:
LPD Scholarship Review Board
209 North Main Street, Suite G
Blacksburg, VA 24060
*As it relates to Coach “Bud” Foster and his wishes to be compliant with all school, NCAA and other relevant regulations, PLEASE BE ON NOTICE regarding the following:
No applicant will be considered who is also being considered for – or is to receive – any athletic aid.
No applicant who is seeking scholarship funds for use at Virginia Polytechnic Institute (“Virginia Tech”) will be considered if said applicant intends to be, or is, in anyway involved with the Virginia Tech Athletic Program and/or has family members attending, teaching or coaching at Virginia Tech and/or is otherwise engaged to be married or married to anyone attending Virginia Tech.
QUESTIONS? Contact Jim Tynan - .
LPD SCHOLARSHIP APPLICATION FORM
NAME & CONTACT INFORMATION
Last Name: ______First Name: ______MI: ______
SSN: ______Gender: □ Male □ Female
Date of Birth (mm/dd/yy): ______/______/______
Current Mailing Address:
______
(Street)
______
(City) (State) (Zip)
Permanent Mailing Address (If different from current):
______
(Street)
______
(City) (State) (Zip)
E-Mail Address______
Phone Number(s) Home: ______Cell: ______
EDUCATIONAL BACKGROUND
Do you have or expect to have (check one): □ High School Diploma □GED □ Foreign Equivalency
Name of High SchoolDates Attended ______
______
Date of Graduation, GED and/or Foreign Equivalency ______/______
(Month)(Year)
Are you currently attending a college or university? □ Yes □ No □ Part-Time
If yes, list ALL universities or colleges you are attending/have attended:
Name of schoolTerm
______
______
MILITARY
Are you: ______Active Duty Military Dependent ______Active Duty Military
Branch/Service ______
CITIZENSHIP/RESIDENCY
Are you a U.S. citizen? □Yes □No
If no, list country of citizenship______Visa type ______
If permanent resident, list card #______Country of birth______
TERM (Choose the term you plan to attend)
□Fall 20______□ Spring 20______□ Summer 20______
EMPLOYMENT AND ANNUAL INCOME[applicant]
Have you ever been employed for more than 4 weeks? □ Yes □ No
If yes, where and when? ______
If yes, please give a short statement as to the “most valuable thing” you took away from that work experience. ______
______
______
Please indicate approximate annual income by checking the appropriate box:
□ Less than $2,000 □ $2,001 - $2,500 □ $2,501 - $3,500
□ $3,501 - $5,000 □ $5,001 - $7,500 □over $7,501
If you have never been employed for at least (4) weeks, please give a brief explanation why. ______
EMPLOYMENT AND ANNUAL INCOME [applicant’s parent(s)/legal guardian]
Parent/Legal Guardian Name: ______
Name of Employer: ______
Job title or Position: ______Dates of Employment:______
Supervisor Contact Information: ______
(Name) (Phone Number)
Please indicate approximate annual income by checking the appropriate box:
□ less than $25,000 □ $25,001 - $35,000 □ $35,001 - $45,000
□ $45,001 - $55,000 □ $55,001 - $75,000 □ $75,001 - $100,000 □ over $100,001
The highest level of education attained by either parent:
□ Associate □ Bachelor □ Master □ Doctorate
EMERGENCY CONTACT INFORMATION
Name: ______Relationship: ______
Mailing Address ______
City ______State ______Zip______
Phone Number(s)_ Home: ______Cell: ______
RACE/ETHNIC ORIGIN (Not required…used for statistical purposes only)
Check any that apply:
□ American Indian □ Black or African American □ Asian
□Hispanic or Latino□Caucasion□Not Specified
ALL APPLICANTS PLEASE READ AND SIGN THE FOLLOWING:
I understand that withholding information requested on this application or giving false information may make me ineligible for admission to the LPD Scholarship. With this in mind, I certify that the above statements are correct and complete. I further understand that from the time I file my application, it is my responsibility to update my application as may be required.
______
(Signature) (Date)
The Lunch Pail Defense provides equal opportunity regardless of race, color, religion, national origin, sex, physical or mental disability.