SAMPLE ONLY

Scholarship Application

Display text

Please complete full application. All fields are required - if not applicable, enter NONE.

You can print a sample of this application above with the PRINT PREVIEW button.

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

Street Address

City

State

Zip

Phone Number

Age

Gender at Birth Male Female

Marital Status

Options: Single / Married / Divorced / Separated / Widowed / Domestic Partnership / Prefer not to say

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

Anticipated Degree Type Associate Degree Bachelor Degree Trade/Certificate School Masters Degree

Activities & Involvement

List (up to 12) of your sports, activities, clubs, volunteer work, and other extra-curricular involvement

Activities

At least 1 row required · up to 12

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

Employment

Father/Guardian Employer

Position

Mother/Guardian Employer

Position

List the jobs you've held during the past two years:

This Year

Position

Last Year

Position

Additional Information

Statement of Need

High School Transcript

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