William Penn Life, 2017 (52. évfolyam, 1-12. szám)

2017-01-01 / 1. szám

11. LIST THREE PERSONAL REFERENCES. EXCLUDING RELATIVES, WHO HAVE KNOWN YOU FOR AT LEAST TWO YEARS (e.g., TEACHERS. CLERGYMEN. COACHES. ETC.):

Name Address Occupation

A

12. LIST YOUR INVOLVEMENT IN WILLIAM PENN ASSOCIATION FRATERNAL ACTIVITIES OR COMMUNITY SERVICE PROJECTS:----------------------------------------------------------------------------------------------------------------------------------------------------------------13. EXTRACURRICULAR SCHOOL ACTIVITIES (i.e., ATHLETICS. THE ARTS, SCHOOL CLUBS):

V____________________________________________________________________________________________________J------------------------------------------------------------------------------------------------------------------------------------------------1

14. SUGGEST AN EVENT OR PROJECT THAT WPA COULD PROMOTE WHICH WOULD INTEREST YOUNG ADULTS:

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15. WILLIAM PENN ASSOCIATION LIFE INSURANCE CERTIFICATE INFORMATION VERIFICATION:

INFORMATION ON BOTH STUDENT Student App|icant

AND PARENT (OR GRANDPARENT)

IS REQUIRED.

Name:_____________________________

CHECK ONE: GParent or DGrandparent of Applicant

Life Insurance Certificate Number: Branch Number:--------------------------------------------------------------------------------------------------------------------------------------------------------------PLEASE NOTE: ALL APPLICANTS must submit an essay not exceeding 100 words, along with this completed application form, to be considered for a grant. The application and essay must be mailed and postmarked by May 31, 2017. NEW APPLICANTS must also submit: (1) a transcript of the student's high school scholastic record; and (2) proof of enrollment for the Fall 2017 school term. RENEWAL APPLICANTS must also submit:

(1) a copy of the student's latest scholastic record showing that the student has maintained a cumulative Grade Point Average of at least 2.5 on a 4.0 scale; and (2) proof of enrollment for the Fall 2017 school term. Failure to submit these items by the date specified in the Eligibility Rules will result in the forfeiture of your grant.

V_______________________________________________________________________________________,_____________A

I hereby certify that I have read the eligibility rules prior to completing this application. I further certify that this application contains no misstatements or omissions of material fact and that the statements herein are to the best of my knowledge complete and correct.

Signature of Applicant

Date

Completed application and essay must be mailed and postmarked by May 31.2017

10 0 January 2017 ° WILLIAM PENN LIFE