Scholarship Application

Section 1 - Personal Information

Name (Last, First, MI, Maiden)*

Student ID (LoLA #)*

Permanent Address (Street, City, State, ZIP Code)*

Date of Birth (month/day/year)*

Phone Number*

Last Four Digits of SSN*

Email Address*

Section 2 - Academic Information

Name of High School*

Guidance Counselor's Name*

Guidance Counselor's Email*

ACT or SAT Composite Score*

Math Score*

Reading Score*

English Score*

Science Score*

Continuing or Transfer Students Only

Please fill out the following section if you are a continuing or transfer student.

Name of College(s)

GPA

Number of Earned Credit Hours

Major

Section 3 - Activities and Interests

How many extracurricular activities are you currently involved in?*

Extracurricular Activity Descriptions

List and briefly describe the two extracurricular activities that are most important to you.

Name of First Organization/Association*

Your Role/Position at First Organization*

Dates of Affiliation/Membership*

Name of Second Organization/Association*

Your Role/Position at Second Organization*

Dates of Affiliation/Membership*

List Honors or Academic Awards You Have Received*

Section 4 - Short Essay

Include a 500 - 800 word essay describing “A memorable food experience you have had, such as a delicious meal you experienced, the 1^st meal you prepared, a family food tradition, etc. and tell us why you are deserving of this $1500 scholarship?”

Enter your essay here.*

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Scholarship Application