The information provided on this form will be used by the LSA Senior Scholarship Committee to select recipients for scholarships. It is important that you give complete details concerning your college/career plans, activities and financial information.

List the major(s) you are considering.

(optional scholarship identification for specific scholarships)

Please list one educator and at least one community person who would recommend you for a scholarship. Please do not list the person who completes a scholarship recommendation for you.

List name of club, etc. and years of participation. If you volunteered, list the name of organization and the number of hours, weeks and years that you volunteered. If you worked, list the company, hours per week and length of time. Attach an additional sheet or resume if necessary.

If you want your student to be considered for this scholarship, you will need to make available a copy of the first page of your most recent tax return and you must complete the information requested below. All information supplied by you will be treated as confidential. If you choose not to submit any financial information, your student will not be considered for the scholarship. Most donors require a financial statement. If your financial circumstances change after you have submitted this form, please feel free to contact us. Complete this entire page if you want your student to be considered.

Stepparent information may replace Mother or Father's information: Please report earnings for the parent/stepparent who the student has lived with most of the time (over 50%) in the past twelve months. If the student lives with both parents equally then provide answers about the parent/stepparent who provides the most financial support.