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Scholarship Application
BEACH LIONS SCHOLARSHIP APPLICATION PERIOD OPEN MARCH 15 - JUNE 10
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FORT MYERS BEACH LIONS FOUNDATION

LOCAL SCHOLARSHIP APPLICATION
P.O. BOX 5019
FORT MYERS BEACH, FL 33932                                                                     

CHECK ONE       _____    I AM APPLYING FOR ONE OF THE GENERAL BEACH LIONS SCHOLARSHIPS    

PERSONAL DATA:

LAST NAME    _____________________________________________________________________________________________

FIRST NAME  ____________________________________________MIDDLE NAME__________________________________________

ADDRESS: _______________________________________________________________________________________________

CITY ______________________________________________  STATE ______________________  ZIP ___________________ 

TELEPHONE ______________________________       EMAIL  _________________________________________________________

SCORES:

SAT _____________    ACT _____________    GPA _____________    CLASS RANK ________

EDUCATIONAL GOALS:

VOC TECH TWO YEAR COLLEGE FOUR YEAR COLEGE  _____________________________________________________________

SCHOOL CHOICE ONE  ________________________________________________________________________________________

SCHOOL CHOICE TWO ________________________________________________________________________________________

SCHOOL CHOICE THREE ______________________________________________________________________________________

MAJOR  ____________________________________________________________________________________________________ 

CAREER GOALS:   ____________________________________________________________________________________________

   ___________________________________________________________________________________________________________ 

___________________________________________________________________________________________________________ 

___________________________________________________________________________________________________________ 

INTEREST IN SORORITY OR FRATERNITY:

____________________________________________________________________________________________________________ 

FAMILY INFORMATION:

FATHER’S NAME  _________________________________________________________   OCCUPATION _________________________

MOTHER’S NAME _________________________________________________________   OCCUPATION _________________________

STUDENT LIVES WITH: ____________________________________________________________________

NUMBER OF SIBLINGS AT HOME _______________     NUMBER OF SIBLINGS IN COLLEGE  ________________________________

WORK EXPERIENCE: _____________________________________________________________________________________________

______________________________________________________________________________________________________________ 

 _____________________________________________________________________________________________________________

 _____________________________________________________________________________________________________________

OTHER: _______________________________________________________________________________________________________

 _____________________________________________________________________________________________________________

 STUDENT ACTIVITIES: List student activities in which you have participated during grades 9-12 and the appropriate grade level. List leadership position held and accomplishments and the grade level.

_____________________________________________________________________________________________________________

: ____________________________________________________________________________________________________________

 _____________________________________________________________________________________________________________

 _____________________________________________________________________________________________________________


COMMUNITY/CHURCH-RELATED ACTIVITIES:
List all community service, non-scholastic volunteer work, and clubs or interests outside of school.

______________________________________________________________________________________________________________ 

______________________________________________________________________________________________________________

 ______________________________________________________________________________________________________________

 
SPECIAL RECOGNITIONS, REWARDS AND HONORS: List commendations not previously listed.

 ______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

APPROXIMATE YEARLY FINANCIAL NEEDS:

TUITION (SCHOOL CHOICE ONE) ________________________    ROOM AND BOARD _______________  BOOKS AND SUPPLIES _______

TUITION (SCHOOL CHOICE TWO) ________________________    ROOM AND BOARD _______________  BOOKS AND SUPPLIES _______


PERSONAL STATEMENT:  
Please describe your reasons and needs for scholarship aid. Include any unusual circumstances. If you need additional space, please write on the reverse of this application. You may also add extra pages. 

 

SIGNATURE: My signature below indicates that all the information contained in this application is complete, factually correct, and honestly presented. I also hereby grant permission to give this form and my academic records to the necessary personnel to be reviewed for awards and/or scholarships.
STUDENT’S SIGNATURE ________________________________________________            DATE ___________________ 


PARENT/GUARDIAN SIGNATURE_________________________________________            DATE ___________________

INSTRUCTIONS: MAIL COMPLETED APPLICATION WITH OPTIONAL PHOTO ATTACHED TO:

Lion DARBY DOERZBACHER
11270 HEIDI LEE LANE
FORT MYERS, FL 33908
APPLICATIONS MUST BE RECEIVED BY MAY 31.


BEACH  
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