Current or GradUllting OPA _ ACT or SAT Score ---

·Stigler Masonic LodgeNo. iliA ..F.&A~M.

Schola:rshipAppli~l.tioB

Applieaat Ipformation

Name: _--'---::"---:-_~ -::::---:- ....,-__ -::-::::--;-::-:, _

relephone:~ --,- _

(Zip)

Length of time at above address: ~ __ ~ __ ---,>_

Age: Marital Status: (Circle. One)Sirigle Married Separated Divorced Widowed

If not a ctll'rent High School Student, are you a graduate: Yes __ No

Which School System: .,.--- _

Other Education: __ ~ ~ _

****'***.** ** *' •• *' * "'*"***"'*'"

Criteria for application

1. Senior Level2; Minimum GPA of 3.0, Minimum ACT of 18

3. Proof of acceptance of a Higher-Education Institution

• List scholarship or loan funds that you have received prior to this application orcurrently awarded:

TypE: AMOUN~ _

TYPE: . AMOUNT: _

TYPE: AMOUNT: _

Will you qualify for OHLAP? Yes--- No---

References

Address:(Stn:dlRoutelP.O.1 (City) (Stale) (Zip)

A. Name of relative:

Relationship:

Telephone:

B. Name of non-relative: --~----------------------------Relationship:

Address:(StfllellRoutelP.O.) (City) (Stale)

(Zip)

Telephone:

B. Please listany Masonic family members;,~ _

D. Letter of Recommendation attached (lletter from non-family)

Please list any work experience andlor citizenship activities you have been active in or arepresently involved with:

Date Signature of Applicant

Applicant's Statement

A. I am applying fo:rfinancial assistance as an incentive to complete my education.

B. I understand that this application is for the sole purpose of scholarship awards madeby Stigler Lodge #121.

C. Stigler Lodge #121 Scholarship Committee members are given permission tocontact any parties or to obtain the source of information which it deems necessaryto very my eligibility and/or informaticn contained within this application.

D. The information given in this application and supporting forms is accurate and trueto the best of my knowledge.

Application must be received by first Friday in April.

Scholarship funds may be paid directly to Applicant or to a Higber EducationInstitution upon proof of acceptance. (A Higher Education Institution = University,College, Junior College or Vo-Teeh.)

Return to:-

Stigler Lodge No. 121 A. F. & A. M.203 N. W. A StreetStigler, OK 74462