Martin Luther King Jr.
Lodge # 29 Prince Hall
Free And Accepted
Masons Jurisdiction of
Arizona, INC.
Book Scholarship Application
Dear Applicant,
Martin Luther King Jr. Lodge # 29 wishes to financially assist a student in the greater Phoenix
area with a book scholarship. The book scholarship is a one-time award and is intended for
students to pursue a University/College/Technical School degree. The book scholarship
program is intended for those students who lack the resources to continue their formal
education. The book scholarship award will be $500.00. Students who have received or
subsequently received full scholarship assistance from any source are not eligible for this
award. Only a member in good standing of Martin Luther King Jr. Lodge # 29 can distribute
this application.
SCHOLARSHIP CRITERIA AND SELECTION PROCESS
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Application (including recommendation form) must be completed, signed, and
postmarked by May 19, 2015. An incomplete application will not be considered.
Please type or print all information.
Applicant must be a high school senior attending school in Arizona, with a verifiable
2.5 GPA or higher in order to qualify for consideration.
MLK # 29 book scholarship is available to all qualified individuals on an equal
opportunity basis, regardless of race, sex, creed, color or religious preference.
All properly completed applications will be evaluated by the Martin Luther King Jr.
Lodge # 29 scholarship committee. The decision of the committee will be final and an
award letter will be sent to the selected applicant.
The selected applicant will be required to furnish documentation (with official school
letterhead from the University/College/Technical school) of full enrollment where
they will be attending in the upcoming fall semester. The book scholarship award can
be forwarded to the University/College/Technical school on behalf of the student.
Return completed application to:
ATTN: Scholarship Selection Committee
Martin Luther King Jr. Lodge # 29
P.O. Box 2654
Chandler, AZ 85225
ATTN: Scholarship Selection Committee
Martin Luther King Jr. Lodge # 29
P.O. Box 2654
Chandler, AZ 85225
Student Profile
Name:
Date of Birth:
Address:
E-Mail:
City/State/Zip Code:
Contact Number:
High School:
E-Mail:
High School Address:
Phone Number:
Cumulative GPA:
Graduation Date:
Verified By:
(Name and Title of Academic Official)
(Signature and Date)
University/College Information: Provide the name of the school(s) you have been accepted to attend.
Please list any other Scholarships or Grants you have been awarded:
Who provided you with this book scholarship?
(Student Signature and Date)
ATTN: Scholarship Selection Committee
Martin Luther King Jr. Lodge # 29
P.O. Box 2654
Chandler, AZ 85225
RECOMMENDATION
This candidate is applying for the Martin Luther King Jr. Lodge # 29 book scholarship. The
program is to financially assist a student in the greater Phoenix area with a $500.00 book
scholarship. Please type or print your responses. All information provided will be reviewed in
confidence.
Name of Reference:
Position/Title:
Address:
City:
Work Phone:
Home Phone:
Zip:
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How long and in what capacity have you known the applicant?
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What do you consider to be the applicant’s primary talents or strengths?
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Comment on applicant’s academic achievement and potential for success
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Rate your perception of applicants in the following areas:(1-5 Scale: 5 being the highest)
Responsibility
(Signature and Date)
Initiative
Character
Academic
Ability
Leadership
Communication
Skills
Leadership Development/Life Experiences
1. Provide a comprehensive and verifiable summary of extracurricular academic
activities, leadership, sports or other achievements:
2. Provide a comprehensive and verifiable summary of your community and charitable
activities that have made a difference in the lives of others.
3. What is your main area of interest in academic studies?
4. What are your career goals?
ATTN: Scholarship Selection Committee
Martin Luther King Jr. Lodge # 29
P.O. Box 2654
Chandler, AZ 85225
5. Submit a detailed essay explaining why you should be chosen over the other applicants
for this scholarship. (Must be a minimum of 500 words)