Scholarship Application – Gate City Lodge No. 42

Name: *

First

Last

Full Address: *

Phone Number: *

Email: *

Please enter your email, so we can follow up with you.

Have you graduated from High School and are currently enrolled in a 4-year college?: *

No
Yes
Not Currently enrolled in college
Yes, but taking a semester off

Please list your most current cumulative GPA: *

What College or University are you enrolled in: *

List your Community Service and/or Extracurricular activities: *

Please name the Brother of Gate City Lodge N. 42 that you are related to and how?: *

List awards and honors you have received in both academic and extracurricular areas: *

Write a short essay about your talents, interests, or activities and/or your plans for the future. The minimum of 200 words and do not exceed 300 words: *

Anything else important we should know about you? *

I acknowledge I must provide proof of enrollment with my application in order to be considered for this scholarship:

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