THE LACKAWAXEN RIVER CONSERVANCY SCHOLARSHIP
INFORMATION FOR COLLEGE STUDENTS
The Lackawaxen River Conservancy is made up of local residents, past and present, from Pike and Wayne
Counties. It is an organization that is dedicated to the protection and preservation of the natural splendor
of the Lackawaxen River, its watershed and wildlife.
The Lackawaxen River Conservancy Scholarship is open to college students who
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intend to pursue a career supporting environmental conservation
are majoring in college in a subject area that will lead to the achievement of this career goal
have graduated from a high school in the Lackawaxen Watershed (The high schools in the
Lackawaxen Watershed are Honesdale High School, Wallenpaupack Area High School, Western
Wayne High School and the Canaan Christian Academy High School.)
have completed at least one semester of college and are currently enrolled in the spring semester
The amount of the award is $500.
APPLICATION REQUIREMENTS
1.
2.
3.
4.
5.
Completed student application
Statement discussing an environmental issue of concern to applicant and why.
High School transcript including GPA
College transcript.
Recommendation from an instructor in a science course or a course required for the student’s
major.
6. Deadline: April 8, 2016.
All application materials should be mailed to the address below:
Scholarship Committee
The Lackawaxen River Conservancy
P.O. Box 176
Rowland, PA 18457
THE LACKAWAXEN RIVER CONSERVANCY SCHOLARSHIP APPLICATION
FOR COLLEGE STUDENTS
Legal Name__________________________________________________________________________
Address_____________________________________________________________________________
___________________________________________________________________________
Home telephone__________________________ Cell phone__________________________________
Email address________________________________________________________________________
Date of birth_________________________________________________________________________
EDUCATION
Current College_______________________________________________________________________
Entry date_______________________ Expected degree and date_______________________________
Previous college or colleges______________________________________________________________
Dates attended________________________________________________________________________
High School___________________________________________ Date of graduation_______________
FUTURE PLANS
Career choice________________________________________________________________________
Major_______________________________________________________________________
Have you applied for financial aid? ________________________________________
Are you a full-time student? __________________________________________________
PARENTS
Name of mother_______________________________________Occupation_____________________
Name of father________________________________________Occupation_____________________
Name of legal guardian (if appropriate) _____________________________Occupation____________
Parents’ marital status in relation to each other: Married_____
Widowed_______
Separated______
Divorced_____
Domestic Partners______
Mother remarried _______
Father remarried _______
Is either of your parents deceased? _______________________________________________________
Is either of your parents enrolled in post-secondary school?_________Name of school______________
OTHER MEMBERS OF HOUSEHOLD
Please complete the list below. Give name of college or post-secondary school if applicable for family
member next year.
Name ______________________Relationship ______Age____ Post-secondary school_______________
Name______________________ Relationship______Age ____Post-secondary school_______________
Name______________________ Relationship ______Age ____Post-secondary school_______________
Name ______________________Relationship ______Age ____Post-secondary school_______________
Name ______________________Relationship ______Age ____Post-secondary school_______________
If more space is needed check here ______and continue on the back of this page.
Please describe any personal circumstances that you would like us to know. _______________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please indicate enrichment experiences that you have had including college courses while in high school,
summer programs or other programs.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
EXTRACURRICULAR ACTIVITIES AND WORK EXPERIENCE
Please list your principal extracurricular activities, including in-school activities, employment, and volunteer
experiences.
Activity _____________________________________________Position held__________________
Hours per week _____________________School year _______ Summer_____ 9 10 11 12 13(+)
Activity _____________________________________________Position held___________________
Hours per week _____________________School year________Summer_____ 9 10 11 12 13(+)
Activity _____________________________________________Position held____________________
Hours per week _____________________School year____________Summer_____ 9 10 11 12 13(+)
Activity _____________________________________________Position held____________________
Hours per week _____________________School year____________Summer______ 9 10 11 12 13(+)
Activity _____________________________________________Position held____________________
Hours per week _____________________School year____________Summer______ 9 10 11 12 13(+)
On a separate sheet of paper please write a complete statement in which you discuss an environmental
issue of concern to you and why. Be sure to include your name and school at the top of your paper.
Applicant’s signature_________________________________________________Date_____________
ACADEMIC REPORT
TO THE APPLICANT
Please complete the following information:
Legal Name___________________________________________________________________________
Current year courses:
Semester 1
Semester 2
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Please provide transcripts from your college and high school. Have the transcripts sent to:
The Lackawaxen River Conservancy
Scholarship Committee
P.O. Box 176
Rowland, PA 18457
INSTRUCTOR’S RECOMMENDATION
Applicant’s name_____________________________________________________________________
The above named student is applying for a scholarship offered by The Lackawaxen River Conservancy.
Please complete this page and provide comments in your evaluation of this student.
Instructor’s name and qualifications (print)
____________________________________________________________________________________
Signature__________________________________________________________Date______________
School Website Address________________________________________________________________
Instructor’s telephone _________________________Instructor’s email__________________________
APPLICANT INFORMATION
How long have you known this student and in what context? ___________________________________
What are the first words that come to your mind to describe this student? ________________________
____________________________________________________________________________________
Please provide comments that will help us differentiate this applicant from others. Please discuss
applicant’s academic strengths and weaknesses. Feel free to provide commentary regarding this
applicant’s financial need in addition to personal and family circumstances that can provide context for
evaluating this student. You may attach an additional sheet or other reference that you may have prepared
for this student.
I recommend this student: No basis_____
Strongly______
Enthusiastically________
With reservation_____
Fairly strongly_____