Society of South Central Texas
An organization that promotes insurance education and community service
Application for LOMA Scholarship
This form should be completed in its entirety. The only changes
authorized to this form are changes to your entries on the form.
An incomplete application may disqualify you from further
consideration.
The LOMA Society of South Central Texas requires that all
applicants complete the “Application Supplement”
attached to this form.
Your Name (Mr./Mrs./Ms. First, Middle Initial, Last name):
Amount of
Scholarship:
Eligibility (Non-LOMA/Family Member, LOMA Family Member, LOMA Member):
Permanent Mailing Address and Contact Information
Street:
City:
State:
Zip:
Home Phone: (
)
Work/Message Phone: (
)
Email Address:
-
Academic Data
Name of Academic Institution and address:
Current student status (e.g. junior,
senior or graduate):
Course of Study/Major:
Expected Student Status, Fall 2011:
Grade Point
Average:
Expected Completion date
of Degree:
Institution in which you will be
enrolled, Fall 2011:
Expected Fall hours:
Sources of Educational Funds
Amounts
I certify that all statements made in this application and the application supplement are true,
and I agree that any misstatement or concealment of fact may subject me to disqualification. I
understand that all the information furnished IS intended solely for the use in determining
whether I qualify for the FLMI Scholarship.
Signature _________________________________________Date ______________________
LOMA Society of South Central Texas
Application Supplement
Please answer the following questions in a concise and factual manner. Your responses
should be in Standard English and all three should total no more than 750 words.
Our selection will be determined in October. If selected as the recipient, you will be
expected to provide us with a photo of yourself for recognition purposes only and attend
our annual Fall Recognition Banquet.
1. What specific area of business do you intend to pursue after graduation from college? Will
your choice include the life or health insurance industry?
2. What have been your most satisfying non-academic activities over the past five years (i.e.
volunteer work)? Could any of these contribute to the success in your eventual career?
3. What characteristic do you consider most important in a business leader? Why is this
characteristic important and when is it most obvious?
Please attach to your application and official current transcript from each post-secondary
institution, which you have attended.
Send your application, your responses to the above questions (be sure to place your name
on this document), and the official transcript to:
Gloria Rodriguez
Chairperson, Scholarship Committee
LOMA Society of South Central Texas
P.O. Box 735
Adkins, TX 78101