NCLOA Scholarship Application Attention: Please return completed application(s) to: Bob Rhodes 20 Lee Drive Farmingdale, NY 11735 E-mail: rulax78@aol.com Tel: (516) 993-044 Answer all the following completely and accurately Please print in ink The information you supply will be held in strict confidence Please mail this application to Bob Rhodes by May 1st This scholarship is open to high school graduates, college undergraduate/post graduate students Your NAME (LAST) (FIRST) (MI) PERMANENT HOME ADDRESS (STREET) (TOWN) (ZIP CODE) TELEPHONE NUMBER DATE OF BIRTH _SEX (CIRCLE ONE) (CIRCLE ONE) MARRIED M F SINGLE NAME OF PARENTS/GUARDIANS IN FULL FATHER _ LIVING? Y N MOTHER LIVING? Y N GUARDIAN _ PARENTS/GUARDIAN ADDRESS (IF DIFFERENT) (STREET) (TOWN) (ZIP CODE) NAME OF NCLOA MEMBER ADDRESS (IF DIFFERENT FROM ABOVE) (STREET) (CITY) (ZIP CODE) The following information MUST be forwarded from either your high school guidance office or from your college via OFFICIAL TRANSCRIPTS If this information is not forwarded showing documentation by the school or schools, then you will NOT be considered for this scholarship SAT/ACT SCORES CLASS RANK GRADE POINT AVG (GPA) LIST ALL HIGH SCHOOLS AND COLLEGES ATTENDED: SCHOOL YRS ATTENDED DATE OF GRADUATION NUMBERS OF BROTHERS AND SISTERS CURRENTLY IN COLLEGE IF IN COLLEGE-WHERE? _ SOURCE OF ANY FINANCIAL AID FOR THEM? _ TO WHAT COLLEGES HAVE YOU APPLIED FOR ADMISSION? SHOW THE LOCATION OF EACH & CITY/STATE FIRST CHOICE _ SECOND CHOICE _ THIRD CHOICE _ IF YOU ARE PRESENTLY ATTENDING COLLEGE, PLEASE NAME THE COLLEGE AND PROVIDE TRANSCRIPTS OF THE DATES ATTENDED AND THE MOST RECENT GPA COLLEGE/ADDRESS _ DEGREE WORKING FOR? GENERAL COURSE OF STUDY WHERE WILL YOU LIVE WHILE AT COLLEGE? (CIRCLE ONE BELOW) AT HOME ON CAMPUS OTHER CIRCLE PRESENT CLASSIFICATION AS LISTED BELOW: HIGH SCHOOL SENIOR COLLEGE SOPHOMORE COLLEGE FRESHMAN COLLEGE JUNIOR COLLEGE SENIOR GRADUATE STUDENT DID YOU EARN ANY MONEY WHILE IN HIGH SCHOOL OR COLLEGE? (INCLUDE SUMMER JOBS) YES NO _ IF YES, HOW DID YOU EARN IT? _ LIST SCHOLARSHIPS THAT YOU HAVE WON LIST AWARDS/RECOGNITIONS EARNED SUBMIT THE INFORMATION BELOW ON A SEPARATE SHEET OF PAPER Provide your extracurricular activities in high school and college such as class office, clubs, newspaper, athletics, et al Please include your outside activities such as community, church/temple, other organizations, boy/girl scouts, 4-H club, etc List any special recognition for excellence in school work, national honor society, and any other activities; your hobbies, favorite activities; any information which you think may assist the committee in gaining knowledge of your abilities and potential Be sure to put your name/address on the top of the paper and include it with this application ... forwarded showing documentation by the school or schools, then you will NOT be considered for this scholarship SAT/ACT SCORES CLASS RANK GRADE POINT AVG (GPA) ... COLLEGE? (INCLUDE SUMMER JOBS) YES NO _ IF YES, HOW DID YOU EARN IT? _ LIST SCHOLARSHIPS THAT YOU HAVE WON LIST AWARDS/RECOGNITIONS EARNED SUBMIT... and potential Be sure to put your name/address on the top of the paper and include it with this application