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, good character, and integrity as well as a commitment to service or involvement within their community. Applications open October 13, 2026 and close April 2, 2027. Recommender forms are due by April 16, 2027 and will be sent to the recommenders' email addresses once applications are submitted.

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.

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.)