Lenape High School Senior Scholarships
Application Information
Any senior who wishes to be considered for local scholarship awards presented at
graduation must fill out this Lenape local scholarship application. Some scholarships are
financial need based, some are not. Most have criteria based on residency, major, GPA,
and other qualifications. Please fill out the application as accurately and completely as
possible. Completed applications can be mailed back to school or the students may
return them to Mr. Rich Jacobs in the Counseling Center. They must be completed and
returned by April 1.
GENERAL DIRECTIONS
Please read the application before completing it. Be sure you understand what
information is requested and make the application legible. Make sure all items on
application are completed and check before turning application in.
1. Write a letter/ statement explaining why you should be considered for an
award/scholarship. This is most important. Please explain why you feel you
should receive scholarship consideration and any special circumstances to be
considered. Application will be considered INCOMPLETE without this
statement.
2. Make sure to fill out the Mount Laurel school attended section. Each Mount
Laurel school gives awards to a student who attended.
SCHOLARSHIP APPLICATION
PERSONAL INFORMATION SECTION
NAME: _______________________________________________________________
HOME ADDRESS: ______________________________________________________
______________________________________________________
PHONE: _________________________ BIRTHDATE: ________________________
College you plan on attending: ______________________Major:___________________
Full Name and address of parents: __________________________________________
Are your parents separated or divorced?_____________________________________
Father’s occupation and place of employment:________________________________
Mother’s occupation and place of employment:_______________________________
Family Members: Please include all siblings living in household.
Name: _________________________Age:____ Grade in School/college____________
Cost if in college__________________
Name: __________________________Age:____Grade in School/college___________
Cost if in college:_________________
Name: __________________________ Age: ____Grade in School/college:___________
Cost if in college:________________
Name: __________________________Age:_____Grade in School/college__________
Cost if in college:_______________
Name: __________________________Age:_____Grade in School/college:_________
Cost if in college:_______________
MOUNT LAUREL SCHOOLS ATTENDED SECTION:
Please check the Mount Laurel schools that you attended and the number of years
at each.
_______Parkway
______Hartford
_______Hillside
______Harrington
_______Countryside
_______Fleetwood
_______Larchmont
_______Springville
ACTIVITIES SECTION: Please list activities you have engaged in during your high
school years. Include school activities as well as organized out-of school activities such
as scouting, church organizations, etc. Indicate years that you participated and any
offices or honors associated with your participation. Please arrange this by type of
activity. In school activities first and then out-of-school activities. Use additional space
or a separate sheet of paper if needed.
IN SCHOOL ACTIVITY
OUT-OF-SCHOOL ACTIVITY
YEARS
YEARS
OFFICE/HONORS
OFFICE/HONORS
FINANCIAL INFORMATION SECTION:
Net family income (combined) _____________________________________________
Comments (extraordinary expenses etc.)____________________________________
Number of cars in family: __________List model and year of each car:
1._____________________________________________________
2.____________________________________________________
3.___________________________________________________
4.___________________________________________________
Did you earn any money while in high school (including summers)? _______________
What kind of work did you do? ____________________________________________
What is total you earned? ____________________How much did you save? _______
Will your parents assist you in furthering your education? ______________________
To what extent? __________________________________________________________
If not please explain: ______________________________________________________
What college do you wish to attend? _________________________________________
What is the cost of the college? _____________________________________________
What will your major be? _________________________________________________
Any scholarships of financial awards from the school? _________________________
Please list and explain: ____________________________________________________
PARENTAL SIGNATURES AND CERTIFICATIONS SECTION
I certify that all statements contained in this application are true and correct, and that I
believe myself eligible to apply for a local scholarship.
The applicant understands that the Scholarship Committee reserves the right to withdraw
a scholarship if it is found that the information requested is falsified or withheld.
Student’s signature: ____________________________________________________
Date: _________________________________________________________________
This application meets my approval:
Parent’s signature: _____________________________________________________
I certify that I am 18 years old and have assumed legal responsibility for myself.
Student’s signature: __________________________________________________
RELEASE OF TRANSCRIPT/INFORMATION
PERMISSION TO TRANSMIT PUPIL RECORDS TO/FROM LENAPE HIGH
SCHOOL
I, as parent or guardian of_______________________________________request that
this school forward as indicated the pupil records of the above.
I understand that the complete school records consists of both mandated and permitted
records; however, I realize that I may restrict the records to be forwarded to mandated
information.
1. I wish to have the complete school record forwarded as indicated
Date: __________ Signature: _____________________________________
Parent/Guardian or Adult Pupil
2. I wish to have only mandated records forward as indicated.
Date: _________ Signature: _______________________________________
Parent/Guardian or Adult Pupil