Scholarship Application

Which type of scholarship are you applying for? (Select One)

Four Year College

Two Year College or Technical School

Agri-Business Program

Applicant Information

Name

Phone Number

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Parent/Guardian Name

Is your parent/guardian a member of Lumbee River EMC?

Yes

High School Information

High School Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Guidance Counselor Name

Class Ranking

Out Of

Cumulative GPA (Unweighted on a 4.0 Scale)

College/University

Which accredited University/Colleges have you applied to?

University/College Name	Location (City, State)	Have you been accepted?
University/College Name	Location (City, State)	Have you been accepted?
University/College Name	Location (City, State)	Have you been accepted?
University/College Name	Location (City, State)	Have you been accepted?
University/College Name	Location (City, State)	Have you been accepted?

What will your course of study / major be?

Clubs & Organizations

(School related activities including class officer, plays, athletics, music, etc.) Include years of membership, offices held, and any honors received.

Personal Achievement

(Non-school related activities including church and community)
List activities you participated outside of school.

Have you received a full-tuition scholarship to the school of your choice?

Yes

Income

All financial and family information in this application will be held in strict confidence by cooperative employees and program judges.

PARENT/GUARDIAN(S) combined adjusted gross income

(From previous year's Federal Income Tax Form)

Other Income (source & amount):

(Social Security, Disability, Child Support, etc.)

The following individuals are supported by my parent/guardian(s). Note their contribution to your family income.

Name and Age	Place of Employment	Income Amount
Name and Age	Place of Employment	Income Amount
Name and Age	Place of Employment	Income Amount
Name and Age	Place of Employment	Income Amount
Name and Age	Place of Employment	Income Amount

Personal Statement and Essay

Personal statement: Write about why you seek this scholarship and how your school/community/work activities have influenced your goals and career choice. This statement should be no more than two double-spaced typed pages.

Essay Questions: Answer the two essay questions below. Your answers should be no more than 400 words, double-spaced typed pages for each question.

1. The lessons we take from obstacles we encounter can be fundamental to later success. Recount a time when you faced a challenge, setback, or failure. How did it affect you, and what did you learn from the experience?
2. Reflect on a time when you questioned or challenged a belief or idea. What prompted your thinking? What was the outcome?

Personal Statement

Upload requirements

Essay

Upload requirements

Additional Uploads

Letter of acceptance from accredited universities or colleges you plan to attend in the fall

Upload requirements

Letter of Recommendation & Transcript

A letter of recommendation from a school principal or guidance counselor and an original high school transcript that includes GPA and class rank should be emailed from the principal or guidance counselor directly to scholarships@lumbeeriver.com

Statement and Signature

We have included all items requested and answered all questions. We understand that incomplete applications will not be considered. We have examined this application and the information is true, complete, and accurate to the best of our knowledge. We understand that if at any time the student discontinues college attendance, all remaining scholarship funds will be forfeited.

Student Signature

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Parent Signature

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800-683-5571