William Penn Life, 2013 (48. évfolyam, 1-12. szám)

2013-02-01 / 2. szám

William Penn Fraternal Association Scholarship Foundation, Inc.

APPLICATION FOR SCHOLARSHIP GRANT (Continued)

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

12. PLEASE EXPLAIN ANY SPECIAL FAMILY CIRCUMSTANCES THE FOUNDATION SHOULD KNOW ABOUT (e.g., MARITAL STATUS, DEPENDENCIES, ILLNESS, SPECIAL HOUSING PROBLEMS, ETC.):

13. WILLIAM PENN ASSOCIATION MEMBERSHIP/BENEFIT INFORMATION:

Student Applicant Parent or Grandparent of Applicant

Name:____________________________________________ ________________________________________

Life Insurance Certificate Number:_____________________________________________ ________________________________________

Branch Number:_____________________________________________ ________________________________________

PLEASE NOTE: For new applicants, you must submit your essay along with this completed application form to be considered for a grant. The application and essay must be mailed and postmarked by May 31, 2013. Also, you must submit: (1) a transcript of your high school scholastic record or college grades; (2) your SAT/ ACT scores; and (3) proof of enrollment for the coming fall term. Failure to submit these items by the date specified in the Eligibility Rules will result in the forfeiture of your grant.

I hereby 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 must be mailed and postmarked by May 31,2013

14 0 February 2013 0 William Penn Life