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:

Section D: Athletics and Extracurricular Activities

List schoolactivities, year(s) of involvement, year(s) of offices held, and year(s) when honors was/werereceived. Check the year in school when activities occurred.

ACTIVITY / 9th
GRADE / 10th
GRADE / 11th
GRADE / 12th
GRADE / LEADERSHIP POSITION/
HONORS BY YEAR

Section E: Community Activities

List all community activitiesin 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