2019 NCLOA Scholarship Application

NCLOA Scholarship Application Attention: Please return completed applications to: Bob Rhodes 20 Lee Drive Farmingdale, NY 11735 E-mail: rulax78@aol.com Tel: 516 993-044 Answer all the f

NCLOA Scholarship Application

Attention: Please return completed application(s) to:

Bob Rhodes

20 Lee Drive

Farmingdale, NY 11735

E-mail: rulax78@aol.com

Tel: (516) 993-044

Answer all the following completely and accurately Please print in ink

The information you supply will be held in strict confidence Please mail this application

to Bob Rhodes by May 1 st This scholarship is open to high school graduates, college undergraduate/post graduate students

Your NAME (LAST) (FIRST) (MI) PERMANENT HOME ADDRESS

(STREET) (TOWN) (ZIP CODE)

TELEPHONE NUMBER

DATE OF BIRTH _SEX (CIRCLE ONE) M F (CIRCLE ONE) MARRIED SINGLE

NAME OF PARENTS/GUARDIANS IN FULL

FATHER _ LIVING? Y N

MOTHER LIVING? Y N

GUARDIAN _

PARENTS/GUARDIAN ADDRESS (IF DIFFERENT)

(STREET) (TOWN) (ZIP CODE)

NAME OF NCLOA MEMBER ADDRESS (IF DIFFERENT FROM ABOVE)

(STREET) (CITY) (ZIP CODE)

The following information MUST be forwarded from either your high school guidance office or from your college via OFFICIAL TRANSCRIPTS If this information is not forwarded showing documentation by the school or schools, then you will NOT be considered for this scholarship

SAT/ACT SCORES

CLASS RANK

GRADE POINT AVG (GPA)

LIST ALL HIGH SCHOOLS AND COLLEGES ATTENDED:

SCHOOL YRS ATTENDED DATE OF

GRADUATION

NUMBERS OF BROTHERS AND SISTERS CURRENTLY IN COLLEGE

IF IN COLLEGE-WHERE? _ SOURCE OF ANY FINANCIAL AID FOR THEM? _

TO WHAT COLLEGES HAVE YOU APPLIED FOR ADMISSION? SHOW THE LOCATION OF EACH & CITY/STATE

FIRST CHOICE _ SECOND CHOICE _ THIRD CHOICE _

IF YOU ARE PRESENTLY ATTENDING COLLEGE, PLEASE NAME THE

COLLEGE AND PROVIDE TRANSCRIPTS OF THE DATES ATTENDED AND THE MOST RECENT GPA

COLLEGE/ADDRESS _ DEGREE WORKING FOR?

GENERAL COURSE OF STUDY WHERE WILL YOU LIVE WHILE AT COLLEGE? (CIRCLE ONE BELOW)

AT HOME ON CAMPUS OTHER

CIRCLE PRESENT CLASSIFICATION AS LISTED BELOW:

HIGH SCHOOL SENIOR COLLEGE FRESHMAN

COLLEGE SOPHOMORE COLLEGE JUNIOR COLLEGE SENIOR

GRADUATE STUDENT

DID YOU EARN ANY MONEY WHILE IN HIGH SCHOOL OR COLLEGE?

(INCLUDE SUMMER JOBS) YES NO _

IF YES, HOW DID YOU EARN IT? _

LIST SCHOLARSHIPS THAT YOU HAVE WON LIST AWARDS/RECOGNITIONS EARNED

SUBMIT THE INFORMATION BELOW ON A SEPARATE SHEET OF PAPER

Provide your extracurricular activities in high school and college such as class office,

clubs, newspaper, athletics, et al Please include your outside activities such as

community, church/temple, other organizations, boy/girl scouts, 4-H club, etc List any

special recognition for excellence in school work, national honor society, and any other activities; your hobbies, favorite activities; any information which you think may assist

the committee in gaining knowledge of your abilities and potential Be sure to put your

name/address on the top of the paper and include it with this application