[ECLH] Scholarship Information Form

[ECLH] Scholarship Information Form
Exchange Club of Lake Highlands
Doug Rabe, Treasurer
P.O. Box 823725
Dallas, TX 75382
(469) 371-7058
treasurer@eclh.org

Due Date: May 4, 2026

Please complete and submit the information below. This information will allow for the processing of the payments to the university or college that you have indicated. Without this information, your scholarship payments will not be processed.

Please note that ½ of the scholarship awarded will be remitted to the university for the Fall semester and ½ for the Spring semester (unless indicated otherwise by the Exchange Club of Lake Highlands).
Legal Name*

First NameLast Name
Home Address*

Street Address

CityState

Zip Code
Phone Number*
Social Security #*
Email*
example@example.com
University or College*
Financial Aid Address*

Street Address

Street Address Line 2

CityState

Zip Code
Financial Aid Phone*
University Student ID
(if known)
Other Relevant Info
Signature*

Clear
Should be Empty: