Visalia Mineral King Masonic Lodge Scholarship Application Form Deadline to submit application to the Lodge is March 24, 2017 Submit to Erin Ferguson, Committee Chairman 5844 W Oriole Visalia, CA 93291 or email to: [email protected]

STUDENT INFORMATION SCHOOL FULL LEGAL NAME Last

First

MI

** PLEASE WRITE YOUR NAME AS IT APPEARS ON YOUR SCHOOL RECORDS

ADDRESS

PHONE NUMBER

CITY

ZIP

EMAIL ADDRESS DATE OF BIRTH

PLACE OF BIRTH

MASONIC AFFILIATION (IF ANY, NOT REQUIRED) FATHER'S NAME (or Guardian) FATHER'S OCCUPATION MOTHER'S NAME (or Guardian) MOTHER'S OCCUPATION NUMBER OF SIBLINGS LIVING AT HOME

NUMBER OF SIBLINGS ATTENDING COLLEGE

EDUCATIONAL AND VOCATIONAL PLANS ANTICIPATED COLLEGE MAJOR VOCATIONAL/CAREER PLANS SCHOOL PLANNING ON ATTENDING

PERSONAL ESSAY- required PLEASE INCLUDE AN ESSAY ABOUT SERVICE TO OTHERS. WHAT IT MEANS TO YOU AND HOW YOU HAVE GIVEN OF YOUR TIME AND TALENTS TO ASSIST OTHERS AND HOW SUCH SERVICE MADE YOU FEEL.

ACTIVITIES RECORD NAME

SCHOOL

STUDENT GOVERNMENT GRADE 9 10 11 12 ORGANIZATIONS/CLUBS GRADE 9 10 11 12 ATHLETICS GRADE

9 10 11 12

AWARDS/HONORS GRADE 9 10 11 12 COMMUNITY ACTIVITIES GRADE 9 10 11 12 HOBBIES

EMPLOYMENT GRADE 9 10 11 12

2017 Masonic Scholarship Packet.pdf

TIME AND TALENTS TO ASSIST OTHERS AND HOW SUCH SERVICE MADE YOU FEEL. Page 2 of 2. 2017 Masonic ... ip Packet.pdf. 2017 Masonic S ... hip ...

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