NCLOA Scholarship Application
Attention: Please return completed application(s) to:
Bob Rhodes
20 Lee Drive
Farmingdale, NY 11735
E-mail:
Tel: (516) 993-0448
Answer all the following completely and accurately. Please print in ink.
The information you supply will be held in strict confidence. Please mail this application to Bob by May 1st. This scholarship is open to high school graduates, college undergraduate/post graduate students.
Your NAME______
(LAST) (FIRST) (MI)
PERMANENT HOME ADDRESS
(STREET) (TOWN) (ZIP CODE)
TELEPHONE NUMBER______
DATE OF BIRTH______SEX (CIRCLE ONE) M F
(CIRCLE ONE) MARRIED SINGLE
NAME OF PARENTS/GUARDIANS IN FULL
FATHER______LIVING? Y N
MOTHER______LIVING? Y N
GUARDIAN______
PARENTS/GUARDIAN ADDRESS (IF DIFFERENT)
(STREET) (TOWN) (ZIP CODE)
NAME OF NCLOA MEMBER______
ADDRESS (IF DIFFERENT FROM ABOVE)
______
(STREET) (CITY) (ZIP CODE)
The following information MUST be forwarded from either your high school guidance office or from your college via OFFICIAL TRANSCRIPTS. If this information is not forwarded showing documentation by the school or schools, then you will NOT be considered for this scholarship.
SAT/ACT SCORES______
CLASS RANK______
GRADE POINT AVG. (GPA)______
LIST ALL HIGH SCHOOLS AND COLLEGES ATTENDED:
SCHOOL YRS ATTENDED DATE OF
GRADUATION
NUMBERS OF BROTHERS AND SISTERS CURRENTLY IN COLLEGE ______
IF IN COLLEGE-WHERE? ______
SOURCE OF ANY FINANCIAL AID FOR THEM? ______
______
TO WHAT COLLEGES HAVE YOU APPLIED FOR ADMISSION? SHOW THE LOCATION OF EACH & CITY/STATE.
FIRST CHOICE______
SECOND CHOICE______
THIRD CHOICE______
IF YOU ARE PRESENTLY ATTENDING COLLEGE, PLEASE NAME THE COLLEGE AND PROVIDE TRANSCRIPTS OF THE DATES ATTENDED AND THE MOST RECENT GPA.
COLLEGE/ADDRESS______
DEGREE WORKING FOR? ______
GENERAL COURSE OF STUDY______
WHERE WILL YOU LIVE WHILE AT COLLEGE? (CIRCLE ONE BELOW)
AT HOME ON CAMPUS OTHER
CIRCLE PRESENT CLASSIFICATION AS LISTED BELOW:
HIGH SCHOOL SENIOR COLLEGE FRESHMAN
COLLEGE SOPHOMORE COLLEGE JUNIOR COLLEGE SENIOR
GRADUATE STUDENT
DID YOU EARN ANY MONEY WHILE IN HIGH SCHOOL OR COLLEGE?
(INCLUDE SUMMER JOBS) YES______NO______
IF YES, HOW DID YOU EARN IT? ______
LIST SCHOLARSHIPS THAT YOU HAVE WON______
LIST AWARDS/RECOGNITIONS EARNED______
SUBMIT THE INFORMATION BELOW ON A SEPARATE SHEET OF PAPER.
Provide your extracurricular activities in high school and college such as class office, clubs, newspaper, athletics, et al. Please include your outside activities such as community, church/temple, other organizations, boy/girl scouts, 4-H club, etc. List any special recognition for excellence in school work, national honor society, and any other activities; your hobbies, favorite activities; any information which you think may assist the committee in gaining knowledge of your abilities and potential. Be sure to put your name/address on the top of the paper and include it with this application.