Membership Info - Contact Joe Sarafini (815) 275-8737 or Terry Anderson (815) 566-7977

Friday, January 16, 2015

2015 - 2016 Club Scholarship Application

Copy the text on this page. Paste into a Word document. Print for completion. Submit/email to Lion Terry Anderson, Lions Scholarship Committee, andersontg@aol.com, (815) 235-0834


               FREEPORT LIONS CLUB  -  “WE SERVE”
          $1000.00  SCHOLARSHIP / 2015 – 2016 / APPLICATION FORM 
(STUDENT MUST ATTEND HIGHLAND COMMUNITY COLLEGE 2015-2016)
 
      FOR YEAR 2015 GRADUATING SENIORS FROM A FREEPORT HIGH SCHOOL.              
 
1.  Name: __________________________ Birth Date: _____________ Phone: _____________
 
2.  Address:_____________________________________________________________________
                                Street / PO Box                                   City                                        State   Zip
 
3.  Father: _____________________________    Mother: _______________________________
     Address:_____________________________              __________________________
    Occupation: __________________________                  _______________________________
    Employer:    __________________________                  _______________________________
    Family Income (combined in 2014):  $_______________ 
 
    Custodial Parent (s): __________________________________________________________
 
4.  Number of Children in Family (Including Self): _____________  (List name(s) & ages)
     _____________________________________________________________________________
 
5.  Brothers / Sisters currently attending college or Vocational / Technical School: (List name(s)
     ages, & college / school)
     _____________________________________________________________________________
 
6.  List Extra-Curricular high school, community, and church activities.
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
 
7.  High School: _________________________ Rank in Class: ______Out of _______ Students.
     ACT score (highest): ___________
 
8.  List any Family Member(s) or Relative(s) who are in a Lions / Lioness Club or who volunteered to
     help for Lions/Lioness Club Activities:
     ____________________________________________________________________________
     ____________________________________________________________________________
 
9.  Attach letter of recommendation from a non-relative, i.e. Teacher, Minister, Priest, etc.
 
10.  Type or print in 200 words or less (on reverse side or attach separate sheet): 
               
                A.  Why you applied.  
                B.  Characteristic(s) about yourself that distinguish you for selection.
                C.  How you feel your chosen field of study could make a difference to serve others.
 
I have read “Basic Requirements for Eligibility” information sheet; I meet those requirements;
and I have answered all questions completely on the “APPLICATION FORM”.  All the
information submitted is correct.
 
Applicant Signature: ________________________________________ Date: _______________
 
Parent Signature: ___________________________________________ Date: _______________ 
 
 
FREEPORT LIONS CLUB
 
Question #10 (200 words or less):
 
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2015 Car Show Planned

The Freeport Lions Club is sponsoring its 2nd Annual
Cruisin' For A Cause Car Show.
The event is planned for Saturday May 9, 2015, at the Union Dairy, 126 East Douglas Street, Freeport Illinois. Stay tuned for more information regarding entry fees and registration. Raffle prizes awarded. This year's show has new categories for both trucks and motorcycles. So get your chrome polish, car wax and elbow grease ready to see some of the areas best customs, and have some fun at this early Spring event!