The Family of Amanda Jane Dombrowski and the Lake Park Educational Foundation Are Pleased

LAKE PARK HIGH SCHOOL EDUCATIONAL FOUNDATION SCHOLARSHIP APPLICATION

Completed scholarship applications must be turned into the Career Center at West Campus by Thursday, March 10, 2016.

Section A: Basic Information

Last Name: First Name: Middle Name: School ID #:

Mailing Address: City: State: Zip Code:

Phone Number: Email Address:

Name of LPHS Counselor:

Please describe your work experience. Include your employer name, job title, responsibilities, dates of employment, and hours per week.

Family Information: Father’s Name: Father’s Occupation: Mother’s Name: Mother’s Occupation:

Number of parents in home, including stepparents:

Number of siblings living at home, including stepbrothers and stepsisters:

Number siblings currently attending college:

Please explain below any specific family financial problems, challenges, or issues the selection committee should be aware of:

Section B: Academic Information Check Weighted or Non-Weighted Class Rank: Cumulative GPA through 7th semester:  Weighted GPA and Class Rank  Non-Weighted GPA and Class Rank

Section C: Future Plans

What college are you planning to attend in the fall of 2016?

Intended college major:

Intended career choice:

Please describe your reason(s) for choosing your future career: 590 South Medinah Road Roselle, Illinois 60172-1978 630-529-4500 Section D: Athletics and Extracurricular Activities List school activities, year(s) of involvement, year(s) of offices held, and year(s) when honors was/were received. Check the year in school when activities occurred. 9th 10th 11th 12th LEADERSHIP POSITION/ ACTIVITY GRADE GRADE GRADE GRADE HONORS BY YEAR

Section E: Community Activities List all community activities in which you participated during your high school years, year(s) of involvement, and any leadership positions held or honors received.

PLEASE MAKE SURE YOU ATTACH THE FOLLOWING TO YOUR APPLICATION:

□ Your unofficial transcript of all high school classes taken

□ The letter(s) of recommendation from a Lake Park teacher, coach, or club sponsor (Some scholarships require two letters of recommendation or letters from a specific subject-area teachers. Please refer to the specific scholarship application for letter(s) of recommendation requirements.)

□ The completed the essay(s) for the scholarship for which you are applying. (See Scholarship Information Packet)

Signature of Endorsement by a Counselor or the Principal: ______

Date Received By Career Center: ______

Please be assured that all applications are treated in the strictest of confidence.

590 South Medinah Road Roselle, Illinois 60172-1978 630-529-4500