2017 Adam M. LaLuzerne Memorial Scholarship Date:_______________________________________________ Lunch Code:_________________________________________ Application Checklist: ____ Applicant: For a continuing Pacelli High School student or graduating senior who exemplifies the work of Saint Teresa & has made a direct impact on those served. GPA is not a deciding factor for this scholarship. ____ Page 1 = This Cover Sheet ____ Page 2 = Typed response to the Community Service question ____ Student’s lunch code must be written on upper, right hand corner of each document (Do NOT put your name on your response pages). ____ Return completed application to Pacelli Counseling Office by 3:00 p.m. April 3, 2017 ____ Paper clip all pages together (NO folders, staples, photos, or additional documents will be accepted) ____ Applications not following the above guidelines will not be eligible for scholarships. Community Service: List community service you performed during grades 9-12. How did you impact those served? You may attach an additional sheet, if necessary.

Organization

Type of Service

Dates of Service & Total Hours

Revised January 2017

UC Adam M LaLuzerne Memorial Scholarship Application.pdf ...

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