Conroe Masonic Lodge Continued Scholarship Application

Conroe Masonic Lodge Continued Scholarship Application

APPLICATION FOR SCHOLARSHIP

(Current application must be used)

Deadline for accepting applications is April 8, 2016

Applications received after the deadline date will not be considered

Name:______

Last First Middle

Permanent Address: ______

Street City State Zip

College/University: ______

Address: ______

Street City State Zip

Phone Number: Applicant’s Permanent (____) ______College/Univ. (___) ______

INSTRUCTIONS

BE CERTAIN THAT ALL REQUIRED DOCUMENTS AND MATERIALS ARE MAILED TO:

Conroe Masonic Lodge, ATTN Scholarship Committee,311 Simonton St.Conroe, TX77301, Phone (936) 756-2435. Inform us immediately if you change your phone number or address.

ELIGIILITY: An applicant must have completed a minimum of 24 college hours and be a resident of Texas and a U.S. citizen to be considered for a scholarship. An applicant is eligible to be considered only if they have previously received a scholarship from Conroe Masonic Lodge.
APPLICATION: This completed application and all required supporting information must be received by April 8th of the current year to be considered.
TRANSCRIPTS: One official high school transcript and one official college transcript for each college/university or vocational/technical that you attended must be submitted also enclose a copy of your SAT, ACT or College Entrance Exam scores.
PERSONAL REFERENCES: Enclose not less than three (2) and not more than six (6) personal recommendations and any additional statements to substantiate information in this application. Personal references may be included with this application or mailed directly to Conroe Masonic Lodge at the address above. Personal references must use the form included in this packet and must include a letter recommending the applicant. Personal reference must use the form included in this packet.
COURSE INSTRUCTION INFORMATION FORM: At least two instructor forms are required from current college or university instructors and can be included with the application or mailed directly to Conroe Masonic Lodge at the address above. Instructor reference must use the form included in this packet.
RECENT PHOTOGRAPH
Applicants should follow up with course instructors and individuals making personal recommendations to verify that references have been submitted. This is the responsibility of the applicant.
INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED.
Recommended by a Master Mason who is a member of a constituent lodge of the Most Worshipful Grand Lodge of Texas - See page 3 of this application for details.

Conroe Masonic Lodge Continued Scholarship Application

PERSONAL DATA

Name: ______

LastFirstMiddle

Address while at College/Univ.______

Street City State Zip

Phone Number (___) ______Alt. Phone Number: ______

Email Address______

Date of Birth: ______Place of Birth: ______Age: ____ Sex: ______

I am a legal resident of: ______

City State Country

Marital Status: ______Spouse’s Name: ______Are you paying non-resident tuition ____

List Dependents: ______

Military Service: ______If Yes, list Branch and years of service: ______

Have you ever been convicted of a Felony? (Circle one) YES or NO. If yes please explain on a separate sheet.

EDUCATION HISTORY

NAME AND LOCATION OF INSTITUTION DATES ATTENDED GRADUATED MAJOR CLASSIFICATION

(MM/YR – MM/YR) (Y or N)

______Y N ______

High School

______Y N ______

College or University

______Y N ______

Vocational or Technical School

Include additional sheet if necessary.

Please list your SAT: ______ACT: ______Entrance Exam: ______Scores. Current (last full-time semester GPA: ______Overall GPA: ______Expected Graduation Date: ______

Degree: ______

List academic achievements or honors received. Please state the year each was received.

______

Educational institution you attend or plan to attend: ______

Describe briefly the major course of study you are pursuing or plan to pursue and your reason for choosing this course of study.______

______(Include additional sheet if necessary).

Conroe Masonic Lodge Continued Scholarship Application

LIST BELOW YOUR ACTIVITIES IN CHURCH, SCHOOL AND COMMUNITY; SUCH AS PUBLICATIONS, CLUB WORK, STUDENT GOVERNMENT, ATHLETICS, HONOR SOCIETIES, ETC.

ACTIVITY / YEAR SPECIAL RECOGNITION, OFFICE HELD

______

WORK HISTORY - List previous work history starting with current or most recent: (Include additional sheet if necessary.)

Dates ofName and addressPhone Position Held Reason for

Employment of Employer Number Leaving

______

Have you received a scholarship from Conroe Masonic Lodge? _____ If yes, what was the date?______

Have you applied for or received other scholarships, grants or stipends? ______If yes, state name and amount. ______

How are you financing your education? ______

______

FAMILY DATA

FATHER/GUARDIANMOTHER/GUARDIAN

Name: ______Name: ______

Home Address: ______Home Address: ______

City/State/Zip: ______City/State/Zip: ______

Occupation: ______Occupation: ______

Employer: ______Employer: ______

Business Address: ______Business Address: ______

City/State/Zip: ______City/State/Zip: ______

Phone: Home: ______Phone: Home: ______

Business/Work: ______Business/Work: ______

List any Masonic Affiliation. (Include additional sheet if necessary.) ______

______

Master Mason recommendation: Print Mason’s Name and Lodge Name & No: ______

______

SIBLINGS: (Include additional sheet if necessary.)

NAMEDATE OF BIRTHSCHOOL OR OCCUPATION

______

How did you hear about this Scholarship? ______

Conroe Masonic Lodge Continued Scholarship Application

INFORMATION RELEASE FORM

INSTRUCTOR REFERENCE FORM

(Please print as many of these forms as needed)

RETURN TO STUDENT OR MAIL DIRECTLY TO: Conroe Masonic Lodge, ATTN: Scholarship Committee, 311 Simonton St. Conroe, TX 77301 Phone (936) 756-2435

I ______

STUDENT'S NAME COLLEGE STUDENT I.D. #

give my permission for my past and/or present instructor ______

INSTRUCTOR’S NAME

to furnish information to CONROE MASONIC LODGE.

The above student has applied for a scholarship at CONROE MASONIC LODGE. Please furnish the committee with the following information. Please try to make your remarks in statement form instead of a one word reply. Please add additional pages as needed. Your assistance in this request is appreciated.

1. CHARACTER/MORALS/INTEGRITY:

2. ATTENDANCE:

3. PUNCTUALITY:

4. ATTITUDE:

5. CLASS PARTICIPATION:

6. WORK HABITS:

7. THEORY CAPABILITIES:

8. LEADERSHIP QUALITIES:

9. GRADE POINT AVERAGE:

10. HOW MANY SEMESTERS/QUARTERS HAVE YOU HAD THIS STUDENT?

11. WOULD YOU RECOMMEND THIS STUDENT FOR A SCHOLARSHIP?

12. WOULD YOU HIRE HIM/HER AS AN EMPLOYEE?

INSTRUCTOR SIGNATURE ______DATE ______

TITLE ______COLLEGE/UNIVERSITY______PHONE NUMBER ______ADDRESS ______

______

LIST ANY MASONIC AFFILIATIONS ______

______

Conroe Masonic Lodge Continued Scholarship Application

PERSONAL REFERENCE FORM

(Please print as many of these forms as needed)

RETURN TO STUDENT OR MAIL DIRECTLY TO: Conroe Masonic Lodge, ATTN: Scholarship Committee, 311 Simonton St. Conroe, TX 77301 Phone (936) 756-2435

PERSONAL REFERENCE FORM

Applicant's Name: ______

1. How long have you known the Applicant? ______

2. Are you related? ______If Yes, what is your relationship?______

3. Do you know Applicant's family? If yes, how long? ______

4. Do you consider this scholarship necessary if so, why? ______

______

5. Do you consider Applicant of good moral character? ______

6. Family's general reputation in the community? ______

______

Any further remarks you think may assist the Committee in the consideration of this

Application: ______

______

Signature: ______Date: ______

Address: ______

Occupation: ______

List Masonic Affiliations: ______

______

2016