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Reminder:
Please make sure that your application is either hand delivered to
Lewis Elementary School by February 10, 2017, or postmarked by
February 10, 2017. Late applications will not be accepted.
Name of
Applicant_____________________________________________________________
Address of Applicant:
Street_____________________________________________________
City_____________________ Zip Code_______________
Phone________________________
Parent or Legal Guardian Name__________________________
Phone___________________
Address_______________________ City________________ State___________
Zip_________
College/University/Trade School of Choice:
__________________________________________
Address:
______________________________________________________________________
Have you been accepted?
Dates
that
you
attended
__________________________________
Essay:
YES
Lewis
NO
Elementary
School:
Please type (double spaced, 12 font) on a separate sheet of paper, in 500 words or less,
why you feel you should be awarded this scholarship. Please include your personal
goals, career plans, and any other information that may persuade the committee that
you should be the applicant chosen.
Relationship_____________
Name__________________________
Phone______________
Relationship_____________
Name__________________________
Phone______________
Relationship_____________
The undersigned hereby acknowledges that the information provided in this application
is true and accurate.
Signature
of
Date____________________
Applicant_______________________________
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