Pooler Lions Club
PO Box 830
Pooler, GA 31322
Chip & Terry Nedza Scholarship
2016Application – DEADLINE: Monday, April 18th
The Pooler Lions Club was chartered in 2011 and our motto is "We serve". This $1,000 scholarship has been established to help area students seeking further education. It is named in honor of our two Guiding Lions, who supported our club, and from whom we learned so much!
Qualifications:
- Pooler resident or Pooler mailing address
- Must have verification of acceptance as a full time student at an institution of higher learning(university,college, vocational or technical school) before receiving scholarship check.
- Grade point average of 2.5 or higher
Conditions:
- April 13th deadline for application to be submitted
- Recent photograph
- Current academic transcript
- Two letters of recommendation - 1 current teacher & 1 adult (non-relative)
- Parents' income tax returns may be requested
- Committee decision is final
- Checks will be made payable to the college in two installmentsfor the first and second semester
General Information:
Name ______
Last 4 Digits Social Security ______Phone Number ______
Mailing Address______
Street Address______
Date of Birth______Place of Birth ______
Current School ______GPA ______Class Rank ______
Father/Guardian ______
Occupation______Employer______
Mother/Guardian______
Occupation______Employer______
Pooler Lions Club
Chip & Terry Nedza Scholarship Application
Page 2 of 3
Have you applied for Financial Aid? Yes ______No ______
Total Family Gross Income (including all members of family):
up to $20,000 ______
$20,000 to $40,000 ______
$40,000 to $60,000 ______
$60,000 to $80,000______
$80,000 to $100,000 ______
Over $100,000 ______
Siblings: (name, age and grade, if attending school):
______
______
______
______
College or University Selected:
Name ______Accepted? Yes ______Pending ______
Address ______Expect to enroll (month & year) ______
______Other scholarships received? ______
Phone Number ______
Please complete the following two essay questions. Please print clearly or type. Additional pages may be added.
1) What would receiving this scholarship mean to you? ______
______
______
______
______
______
______
Pooler Lions Club
Chip & Terry Nedza Scholarship Application
Page 3 of 3
2) Please describe your involvement in the following areas, including any awards or special acknowledgements: Community service, clubs and organizations, academics, hobbies, special interests, and work experience.
______
______
______
______
______
______
______
Certification:
- I hereby certify that the information provided in this application was written solely by the undersigned and that the data is true and correct as of this date.
- I consent to the review and release of this information to the Pooler Lion's Club Scholarship Committee.
- I understand the Pooler Lions Club requires my social security number for its records.
- I agree and grant permission for use of my name and other information for the purposeof promotion, advertising, recognition and/or news releases, including publications, to the Pooler Lions Club,
without promise of favor or payment.
Applicant Signature______Date ______
Parent/Guardian Name ______Date ______
*Parent/Guardian Signature ______
*(Needed if the applicant is younger than 18 years of age at the time of theapplication.)
PLEASE MAIL COMPLETED APPLICATION TO:
Pooler Lions Club
PO Box 830
Pooler, GA 31322