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DOOLEY LEAH REBEKAH LODGE FOUNDATION
The Dooley Leah Rebekah Lodge foundation was established for the purpose of providing scholarships to graduating students from Goldendale High School. The scholarships are for students planning on attending college, trade school, or other forms of higher education. Scholarship recipients will be announced at graduation.
TURN IN APPLICATION TO GOLDENDALE HIGH SCHOOL CAREER CENTER SECRETARY BEFORE APRIL 15.
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NAME:
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ADDRESS:
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PHONE:
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DATE OF BIRTH
MM
/
DD
/
YYYY
FATHER'S NAME
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FATHER'S OCCUPATION
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MOTHER'S NAME
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MOTHER'S OCCUPATION
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BROTHERS AND SISTERS (INCLUDE AGES)
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SIBLINGS IN COLLEGE (HOW MANY?)
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NAME OF SCHOOL YOU PLAN TO ATTEND:
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ADDRESS OF SCHOOL YOU PLAN TO ATTEND:
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DO YOU PLAN ON BEING A FULL-TIME STUDENT IN THE FALL? IF NOT, WHEN DO YOU PLAN TO START?
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AREA OF STUDY - WHAT DO YOU WANT TO STUDY AND WHY?
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GOALS - WHAT ARE THE SHORT AND LONG TERM GOALS FOR YOUR LIFE?
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ORGANIZATIONS - PLEASE LIST COMMUNITY ORGANIZATIONS SUCH AS SERVICE, VOLUNTEER, RELIGIOUS, AND OTHER COMMUNITY ORGANIZATIONS WHICH YOU HAVE PARTICIPATED IN. LIST OFFICES THAT YOU HAVE HELD. (Example: scouting 4-H, grange, and church groups).
Community Service Record complete
EMPLOYMENT - PLEASE DESCRIBE ANY PAST OR PRESENT JOBS YOU HAVE HELD, INCLUDING INFORMATION CONCERNING DUTIES AND RESPONSIBILITIES OF EACH JOB. VOLUNTEER WORK, FOR WHICH YOU WERE NOT PAID, SHOULD BE INCLUDED AND WORK DESCRIBED.
Employment Record complete
LETTERS OF RECOMMENDATION: TWO CURRENT LETTERS OF RECOMMENDATION (FROM WITHIN THE LAST YEAR) AND SUBMIT THEM IN SEALED ENVELOPES WITH YOUR APPLICATION.ONE SHOULD BE FROM A TEACHER, PRINCIPAL, OR SCHOOL COUNSELOR. THE OTHER LETTER SHOULD BE FROM A BUSINESS PERSON, CLERGY, OR OTHER PERSONS IN THE COMMUNITY.
Letter from TEACHER, PRINCIPAL, OR SCHOOL COUNSELOR AND
Letter from BUSINESS PERSON, CLERGY, OR COMMUNITY MEMBER
STATEMENT OF ACCURACY: I HEREBY AFFIRM THAT ALL THE ABOVE STATED INFORMATION PROVIDED BY ME IS TRUE, CORRECT AND WITHOUT FORGERY. I HEREBY UNDERSTAND THAT IF I AM CHOSEN AS A SCHOLARSHIP WINNER, I MUST PROVIDE EVIDENCE OF ENROLLMENT/REGISTRATION AT THE INSTITUTION I WILL ATTEND BEFORE SCHOLARSHIP FUNDS CAN BE AWARDED. THE FUNDS WILL BE SENT DIRECTLY TO THE NAMED INSTITUTION.
PROOF OF ENROLLMENT/REGISTRATION
SIGNATURE OF SCHOLARSHIP APPLICANT AND DATE:
Your answer
THE FOLLOWING ITEMS MUST PRINTED AND ATTACHED TO THIS APPLICATION TO OUALIFY AND TO BE REVIEWED BY THE SCHOLARSHIP COMMITTEE.
1. COPY OF MOST RECENT OFFICIAL HIGH SCHOOL TRANSCRIPT OF GRADES INCLUDING CLASSES TAKEN.Option 1
2. PROOF OF COLLEGE OR SCHOOL ACCEPTANCE WITH STUDENT ID NUMBER.
3. TWO CURRENT LETTERS OF RECOMMENDATION.
4. APPLICATIONS MUST BE RECEIVED OR POSTMARKED BY APRIL 30TH
5. APPLICATION MUST BE COMPLETE.
6. ATTACH A SEPARATE SHEET OF PAPER FOR YOUR ANSWERS . APPLICATION ANSWERS MUST BE PRINTED IN INK OR TYPED.
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