Gus LeBlanc Memorial Scholarship Application

Gus LeBlanc Memorial Scholarship

The information provided on this form will be used by the Gus LeBlanc Memorial Scholarship Committee to select recipients for scholarships. It is important that you complete all required elements of this form before submitting. Applicants must be high school seniors on track to graduate from a public Androscoggin Valley high school (Edward Little, Leavitt, Lewiston, Lisbon, Oak Hill, or Poland Regional) with plans to attend a two- or four-year college or university and who demonstrate qualities of leadership, perseverance, character, and integrity as well as a commitment to service or involvement within their community. Applications open October 27, 2025 and close April 17, 2026.
BASIC INFORMATION
Student's Full / Legal Name*

First NameLast Name
Student's Preferred Name (if different from above)

First NameLast Name
Student Pronouns*
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student Phone Number*

Area CodePhone Number
Student Email*
Which high school do you attend?*

Edward LittleLeavittLewistonLisbonOak HillPoland
Student Birth Date

MonthDayYear
Academic GPA*
Please upload a photo of you that we can use on our website if you are a recipient of this scholarship.

Browse Files

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Short Essay Responses

Please answer each of the following prompts in approximately 200-500 words. We suggest writing the responses in a separate doc and then copying and pasting them here, to avoid losing your work accidentally should the page refresh, etc.
Throughout your high school career, how have you demonstrated qualities of leadership as well as a commitment to service and/or involvement within your community?*
What does your college education mean to you? How will it help you achieve your goals? How will it positively affect your life?*
Recommender

Please provide the contact information of an adult who can speak to your academics, your character, and your integrity. (This should be a teacher, advisor, guidance counselor, administrator, or coach with a school district email address.)
Recommender's Full Name*

First NameLast Name
Recommender's Email Address*
Recommender's Phone Number (optional)

Area CodePhone Number
Recommender's Role (teacher, coach, counselor, etc.)*
Submission Time

MonthDayYearHourMinutesAM/PM Option
Should be Empty:

Gus LeBlanc Memorial Scholarship

BASIC INFORMATION

Short Essay Responses

Recommender