LCP Memorial Scholarship Application

Recommendations

Below, please provide the names, titles/positions of the two persons you have requested to submit personal recommendations on your behalf.
Person 1
Name*

First NameLast Name
Title/Position*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Person 2
Name*

First NameLast Name
Title/Position*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.

Volunteer Experience

List most current first:
Title
Date

MonthDayYear
Date
Organization
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties
Title
Date

MonthDayYear
Date
Organization
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties
Total years of volunteer experience
List student clubs, organizations, and any extracurricular activities you are involved in.
Additional comments:
By signing below, I state that the information provided by me in this application is truthful and accurate. I understand that if I provide any misleading information for this application, my award may be forfeited if I am determined a recipient.
Name (Print)*

First NameLast Name
Signature*

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Date

MonthDayYear
Date

Essay Question

The screening committee seeks to know what has influenced the development of your personality and values. Choose one of the following two topics as the subject of your essay:
1. What is your most memorable moment and how has it shaped your life?

2. How will your planned career goals impact the community as a whole?
Which option have you chosen as the subject of your essay?
Write personal essay here:*
Statement should NOT exceed 500 words.
Should be Empty:

Recommendations