The Lakewood Business and Professional Women's Club
Scholarship Application

Applicant's Name: ____________________________________________________

Home Address: ______________________________________________________

Home Phone: ___________________       Birthdate: ________________________

Are you a U.S. citizen?  Yes _____   No _____

Family Information: (*Complete these items if you will be attending college/university as a traditional student)

*Number of Siblings: _________  *Ages of Siblings: ______________________________

Number of Children: _________    Ages  of Children: _____________________________

Combined Household Income (Annual): _____________________

Education History:

Please list in the space below any scholastic honors you have received.

Please list in the space below any extracurricular activities in which you participate(d). Include the grade or collegiate year you participated and any positions held.

Please list in the space below any volunteer experiences. List the name of the orginization, type of activity or service provided, any positions held, and the dates of  involvement.

 

 
 

Employment History: 

Will you be working during the school year for which you are applying for this scholarship?
Yes____  No____   Full time _____   Part time ______
If yes, please list the name and address of employer as well as job title/responsibilities below:

List any other scholarships, loans, or grants you will be receiving for the school year for which you are applying:

Have you been accepted into the educational institution and/or program for which this scholarship is being requested?  Yes ______  No______

Name of Educational Institution:______________________________________________________________

Address:________________________________  City, State__________________  Zip Code _____________

Type of institution:  4 yr. College/University ____    Vocational/Technical ____    Community College ____

Will your academic schedule be full or part time? ______________________________________________

Field of Study/Major:_______________________  Type of degree being sought (AA, BA, etc.):________

Starting date of study: ____________________     Expected graduation date: __________________

     

Name two adult references (other than counselors or relatives) who can support your nomination for a scholarship:

Write a paragraph regarding your future plans.   Include schools to which you have applied or are currently attending.

Optional: Describe any unusual circumstances, which might be helpful in evaluating your application:
 
 
 

Are you a BPW member? _________________     If  yes, local organization: ____________________

How did you learn about the Lakewood BPW Scholarship program? ________________________

Student signature: _______________________________________     Date: _____________________

Parent or guardian's signature: _____________________________      Date: _____________________
(if attending college/univeristy as a traditional student) 

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