KOP Scholarship Application 2024

KNIGHTS OF PYTHIAS – GRAND DOMAIN OF INDIANA

EDUCATIONAL ASSISTANCE PROGRAM
KOP District
Requirements to accompany the application form:

Two Essays

• Essay One: Your Goals after Graduating
• Essay Two: Why do you Need Financial Assistance

Latest High School/ College Transcripts
Other supporting documents to support your application
Which type of applicant are you applying for?

Public Only ApplicationPythian Family Application (Senior HS)Pythian Family Application (College)
Personal Information
Name*

First NameMiddle NameLast Name
Nick Name
Address*

Street Address

Street Address Line 2

City

Zip Code
City or Town you live
County
County you live
Country of Residence
County
Phone Number*
Email*

Confirmation Emailexample@example.com
Parents Information
Father's Name

First NameLast Name
Father's Occupation
Father's Place of Employment
Mother's Name

First NameLast Name
Mother's Occupation
Mother's Place of Employment
Guardian's Name

First NameLast Name
Relationship to Guardian
Residing with (check one)

FatherMotherBoth ParentsOther
Annual Family Income (in US$)
enter the family annual income in decimals e.g. $ 1213.00
Is this Annual Family Income Gross Income of Net Income?

Gross IncomeNet Income
If you have worked, list any of your employers during your last years in High School
Enter one employer per line
List the number of your brothers and/ or sisters and their ages
one name per line
Do you have any other family member/s enrolled in college?

YesNo
How many of your family members are also enrolled in college?
List the name of the colleges that your other family members attend?
one college per line
Do you have any unusual family situation/s which we should know?

YesNo
Explain any unusual family situations of which the committee should know:
School Information
Name of High School you are attending now
Address of High School you are attending now

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
High School Phone Number
HS Counsellor's Name
Name and Complete address of College(s) that you have applied to and/or been accepted:
List any awards or honors achieved by you (be specific):
List school activities you participate in:
List community activities you participate in:
Are you a Pythian?

YesNo
Lodge/Temple name/number you belong to:
If you are not, list the name of your Pythian affiliation and what relationship you are to the Pythian member:
What Lodge or Temple do they belong to?
Essay 1: What are your goals after Graduation? (You can type in your essay here or attached a copy on your final form when submitting.)
Essay 2: Why do you think you need Financial Assistance? (You can type in your essay here or attached a copy on your final form when submitting.)
Type your name to confirm submission*

First NameLast Name
Signature of Applicant

Clear
Date Signed

MonthDayYear
Date
Upload your supporting documents here

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KNIGHTS OF PYTHIAS – GRAND DOMAIN OF INDIANA