Scholarship Application Form

The Lincoln-Lane Foundation
Application for Financial Assistance for High School Seniors
Name*

First NameMiddle InitialLast Name
First Name and Middle Initial
Last Name
Name you prefer to be called:
Date of Birth*

MonthDayYear
Date
Place of Birth*
City, State
Student's Mobile Phone Number*
We will call you to set up interviews.
Student's E-mail Address*
We send important information to your email.
Are you a US Citizen?*

YesNo. If selected, please provide a copy of your green card.
Green Card (for non-US Citizens)

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Gender*
Gender
Will you be a first generation college student?

YesNo
Home Address*

Street Address

Apt/Unit #

CityState

Zip Code
School Currently Attending*
Please all High Schools Attended in Grades 9 - 12 with years
Access Advisor's Name
Current Cumulative GPA*
Transcript with class rank must be sent to us directly from your High School. See Below.
Rank in Class
Example 32/400.
Please have your transcript with class rank sent directly to us by your Guidance Counselor. It may be emailed to lincolnlane1@gmail.com or mailed to 207 Granby Street, Suite 302, Norfolk VA 23510.
Upload ACT/SAT Score Document

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Scholastic honors or distinctions received:
Extracurricular activities and dates of participation:
If you have a job after school, how many hours a week do you work?
Colleges to which you are applying. Please star if you have first choice.
Expected Year of College Graduation
Expected Major
Year for which you are applying:

	Dollar Amount
Wages
Pension
Social Security
Child Support
Any other income (please label)

	Dollar Amount
Wages
Pension
Social Security
Child Support
Any other income (please label)

	Dollar Amount
Wages
Pension
Social Security
Child Support
Any other income (please label)

Requirements to Complete your Application
Student Photo*

Submit a recent photo.
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We interview prospective candiates one time. The photo helps us recall our scholarship recipients when we do our annual renewal reviews. Please submit a current photo.
FAFSA Submission Summary

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Upload your FAFSA Submission Summary with your SAI as soon as it is available.

If you don't have the Summary at the time of application submission, you may email it to us at lincolnlane1@gmail.com.
Please request the following from your teachers and counselor:
- 2 letters of recommendations from someone who is familiar with your academic work. The letters must be sent directly to us from the author.
- A transcript with class rank sent directly to us from your current school.
The items above may be emailed to lincolnlane1@gmail.com or mailed to:

The Lincoln-Lane Foundation
207 Granby Street
Suite 207
Norfolk, VA 23510
* (Please initial) I have requested two letters of recommendation and a transcript to be sent directly to The Lincoln-Lane Foundation.
Important Dates and Timeline for New Applicants

Agreement
If I am awarded a grant from The Lincoln-Lane Foundation, I agree to notify The Foundation of the amounts of all other financial assistance I receive in addition to the grants and loans awarded by my college.

I also agree to notify the Foundation if I cease to be a full-time student in good standing or if I withdraw from school before the end of a regular semester.

I understand that it is my responsibility to have a college transcript sent to the Foundation from my college registrar at the end of each semester.
Signature*

Clear
Date

MonthDayYear
Date
NOTICE OF NON-DISCRIMINATORY POLICY
“The Lincoln-Lane Foundation accepts applications from students of any race, color, national or ethnic origin. It does not discriminate on the basis of race, color, national or ethnic origin in the administration of its educational scholarship funds. The Foundation adheres to and complies fully with the provisions of The Civil Rights Act.”

The Lincoln-Lane Foundation