Scholarship Application

Code

Email Address *

Name of Sponsoring Mason *

Relationship to Applicant *

Masonic Affiliation

Masonic Lodge

Youth Organization

Name of Chapter

Applicant Personal Information

Applicant's First Name

Last Name

Middle Initial

Home Address

Phone Number

Age

Gender at Birthday

Marital Status

Email Address 2

Optional secondary email address

EFC/SAI

Expected Family Contribution / Student Aid Index

Siblings

Total number of siblings

Siblings in College

High School Information

Name of High School

High School Street Address

High School City

High School State

High School ZIP

Academic Information

GPA

Enter your cumulative GPA on a 4.0 scale

SAT/ACT Combined Score

SAT/ACT Math Score

SAT/ACT Written Score

Anticipated Major

College/University, Technical/Trade School Attending in the Fall

Name of the college, university, technical, or trade school you will attend

Activities & Involvement

Sports, Related Activities and Extra-Curricular Activities (In School / Out of School)

Include both in-school and out-of-school activities

Teacher Recommendations

Recommendation from Teacher 1

Provide the name and contact information for your first teacher recommendation

Recommendation from Teacher 2

Provide the name and contact information for your second teacher recommendation

Recommendation from Teacher 3

Provide the name and contact information for your third teacher recommendation