Pennsylvania Masonic Youth Foundation Scholarship Application

Pennsylvania Masonic Youth Foundation Educational Endowment Fund 2017 Scholarship Application

Applications must be postmarked no later than March 15, 2017.

This is a highly competitive grant program and cannot be given to all who apply. Please type application, or print in ink. Do not use pencil. Incomplete applications will not be considered.

SECTION 1: PERSONAL DATA

Name:

Address:

County: City: State: ZIP:

Telephone Number: () - E-mail Address:

Alt. Phone Number: () - Gender: Male Female

Birthdate: Age:

Are you a current resident of Pennsylvania? Yes No

If not currently, have you ever been a resident of Pennsylvania? Yes No

Number of Years as a Resident:

SECTION 2: ELIGIBILITY

Name of Masonic Relative: Relationship:

PA Lodge Name: Lodge Number:

If your father is a Deceased Pennsylvania Mason? Yes No

Are you a member of a Masonic-related youth group? Yes No

Are you a member in good standing of the Acacia Fraternity? Yes No

Are you a resident or graduate of the Pennsylvania Masonic Children’s Home? Yes No

Attachment Required: Certification of eligibility

Check here if attached.

SECTION 3: ACADEMICS

Name of High School Attended:

Address:

Were you selected as a Salutatorian Valedictorian?

Year Graduated: Class Rank: No. of Students:

Are you attending a:

College University Business School Trade School

Name of Institution:

Address:

Class in which you will be enrolled as of the fall 2017 semester:

Freshman Sophomore Junior Senior

Current Student Status at College:

Full Time Part Time Enrolled for next academic year

Major Course of Study:

Minor Course(s) of Study:

Do you anticipate transferring or attending a post-secondary school different than the one listed above? Yes No

If yes, list name of post-secondary school:

Current G.P.A.: on a scale of

Critical Reading: Writing: Math:

If S.A.T. scores are not available, please explain why.

Is the National Honor Society available at your High School? Yes No

Are you a member of the National Honor Society? Yes No

If you hold an office in the National Honor Society, list it here:

List other academic honor societies and academic school clubs in which you hold membership:

PERSONAL GOALS ESSAY

Please state your primary educational and lifetime goals, in your own words, in paragraph form, using 50 to 100 words.

PERSONAL EXPERIENCES ESSAY

“Pick one experience from your own life and explain how it influenced your development.”

Attachment Required: Original transcript

Check here when attached.

Check here if school will be sending transcripts.

SECTION 4: FINANCIAL NEED

Do not leave any lines blank. If financial information is not available, provide a reasonable estimate.

Savings and Investments:

Monies earned by working during the summer:

Monies earned by working during school the year:

How much will your parents/guardians contribute?

Other contributions:

Total of all Contributions:

Educational Expenses

Cost of Tuition:

Transportation:

Cost of Room and Board:

Cost of Books and Supplies:

Other Expenses:

Total of All Expenses:

List financial aid (scholarships and grants but not loans) that you have been approved to receive for the next academic term:

List any other expected sources of grant assistance or loans:

List names of dependent children in the family (other than applicant) who are CURRENTLY ENROLLED in a post-secondary school:

Name: School Attending:

Name: School Attending:

Name: School Attending:

Name: School Attending:

SECTION 5: FRATERNAL ACTIVITIES

Are you (the applicant) a Pennsylvania Mason? Yes No

If yes, PA Lodge name and number:

Are you (the applicant) a member of the Acacia Fraternity? Yes No

If yes, PA Chapter name and location:

Are you now, or were you, upon reaching your majority, a member in good standing of any of these Masonic Youth Groups?

DeMolay Rainbow for Girls Job's Daughters

Group Name and Number:

Have you served as a local elected officer? Yes No

Have you served as a local presiding officer? Yes No

Have you served as an appointed state level officer? Yes No

Have you served as an elected state level officer? Yes No

Have you served as a state level presiding officer? Yes No

Have you served as a national officer? Yes No

Please list the highest office attained at each of the levels below:

Local:

State:

National:

Please list any fraternal honors, awards, or citations received:

SECTION 6: EXTRACURRICULAR ACTIVITIES

List memberships in non-academic clubs, civic activities, community, political and religious organizations:

Please list your accomplishments in these organizations (such as serving as an officer, receiving awards and honors, or other achievements.)

You may ATTACH A STATEMENT providing any additional details of Your Other Activities.

Check here when attached.

SECTION 7: CERTIFICATION

I certify that all information contained herein, or attached, is correct to the best of my knowledge, and I have made no effort to hide pertinent information from the committee.

Where did you find out about this scholarship program? (Check all that apply)

Masonic Scholarship Resource Guide The PA Freemason magazine

Parents Grandparents Masonic Youth Group Leader

School Guidance Counselor Other: