You must be of Norwegian descent; a legal resident of Clark County, Nevada, or a member of the Vegas Viking Lodge or child or grandchild of a member of the lodge; at least a senior in high school; and you must maintain full-time student status to be eligible for this scholarship. The scholarship value is at least $500 and must be used for posthigh school studies. Please print or type all information. All questions must be answered or designated as N/A if not applicable. Failure to answer the questions on this three-part, three-page application may negatively affect its evaluation.
Part I - Personal information:
Name:______________________ Email____________________ Birth date: ________
Address:________________________________ Phone Nos.:_____________________
Father's name:____________________ Mother's name:_________________________
Address:_________________________ Address:______________________________
________________________________ _____________________________________
Phone: ___________________ Phone: _______________________________
Total family income from all sources: ___Below $15,000 ___; $15,000 - $30,000;
___$30,000 - $45,000; ___$45,000 - $60,000; ___ $60,000 - $75,000; ___$75,000 -$90,000;
___ $90,000 - $105,000; ___$105,000 - $120,000; ___$120,000 - $135,000; ___above $135,000
This application and the following attachments must be postmarked no later than
April 19, 2014 , and sent to:
Vegas Viking Scholarship Committee
Suzan Sibert
5980 W. Alfred Drive, Las Vegas, NV 89108 in order to be eligible for selection:
A. Transcript(s) of grades from this year and cumulative grades to date.
B. A photocopy of your driver's license or other photo identification.
Under penalties of perjury, I declare that I have examined this application, accompanying attachments and statements and, to the best of my knowledge and belief, they are true, correct and complete. I also understand that the information contained in this application is subject to verification by the Sons of Norway Vegas Viking Lodge and that any information found to be false or inaccurate may result in the denial or cancellation of any scholarship award and the requirement to return to the Sons of Norway Vegas Viking Lodge any funds awarded.
Signature_______________________________ Date:________________________

Part II - Scholastic and financial information:
1. Describe how you are of Norwegian descent: ________________________________
______________________________________________________________________
______________________________________________________________________
2. What is your cumulative, unweighted grade-point average based on a 4.0 scale:_____
3. Describe what college, university or technical school (not necessarily in Clark County) you wish to attend along with your major, area of study and career objectives: _______
______________________________________________________________________
______________________________________________________________________
4.List all extra-curricular activities you have been involved in during the past three years:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
5. Do you need to work to attend school:______________________________________
6. If currently employed, please provide this information:
Employer:______________________________________________________________
Hours per week: ______ Annual salary: $_____________
7. Father's employer: __________________Mother's employer:____________________
Address:________________________ Address:__________________________
________________________ __________________________
Job title:________________________ Job title:____________________________
How long:_______________________ How long:__________________________
Annual salary:____________________ Annual salary:__________________________
8. How many children in your family live at home?______ Do you live at home?____
9. Do you have dependents?________ If yes, how many?________
10. How many of the children in your household, other than you, are now attending college? ____
Part III – Essay:
Print or type a brief essay on the reasons you are applying for this scholarship, how it will benefit you and any other extenuating circumstances that could help the Sons of
Norway Vegas Viking Lodge determine your need for a scholarship. Limit the essay to the space provided on this page and the next. If you use a word processor, your essay must be no more than two pages in length,1.5 or double-spaced, in 12-point font.

The Vegas Viking lodge ( www.vegasviking.com
) was organized in May 1992 and has been involved in a wide variety of special events featuring traditional and contemporary programs having a Norwegian-American flavor ever since. As part of the Sons of Norway, it is a fraternal benefit and cultural society dedicated to preserving Norwegian heritage in North
America and strengthening the ties between North America and modern Norway. Vegas Viking also helps charities through donations.