Amherst County Scholarship Application
Continuing Education at 2/4 year college, Professional Trade or Apprenticeship
Please Type or Write Neatly
Please fill out the application in detail, and return it along with a copy of your grades (unofficial
transcript or print out from the web) verifying your GPA by April 12, 2019 to Amherst County
Lions Club PO Box 84 Sweet Briar VA 24595. Any late or incomplete applications will not be
considered and will be disqualified.
Full Name _____________________________________________________________________
School Address_________________________________________________________________
Permanent Address______________________________________________________________
Email Address__________________________________________________________________
Date of Birth____________________ Sex: Female ___ Male__
Current GPA_______________ Attach copy of High School Transcript to application
In what volunteer or Community Services activities or organizations have, you participated.
(Indicate any offices held) use separate paper if needed:
1_______________________________________________________________________
2_______________________________________________________________________
3_______________________________________________________________________
4_______________________________________________________________________
5_______________________________________________________________________
List awards, honors and scholarships received:
1________________________________________________________________________
2________________________________________________________________________
3________________________________________________________________________
List positions held in gainful employment during the last 12 months:
1_______________________________________________________________
2_______________________________________________________________
3_______________________________________________________________
List of the two people you had write Letters of Recommendation:
1. Name ________________Relationship_____________Phone number ____________
2. Name ________________Relationship_____________Phone number ____________
Statements: On a separate sheet of paper, type in 12-point font and double-spaced each
response in 500 words or less.
First Question: After researching the history of the Lions Club and the causes supported by
Lions comment on one in particular and its importance to the local community.
Second Question: I believe giving back is essential to the fostering of a healthy community.
Three things I think community or civic organizations should be addressing are:
I HEREBY CERTIFY THAT THE ENTRIES ON THIS APPLICATION ARE TRUE AND ACCURATE TO
THE BEST OF MY KNOWLEDGE AND BELIEF.
Signature_______________________________ Date_________________
Applicant Check List:
_____Application form completed and signed
_____Answers on separate paper for the two essay questions
_____Transcript copy (high school)
_____Two letters of recommendation
_____ Copy of College/School acceptance letter or Email
_____Address of Financial Aid Office at college, trade school or apprenticeship to send scholarship
money
Any Lions club scholarship application that is received and does not follow the rules and
guidelines set forth by the Lions Club Scholarship Committee will be automatically disqualified.
Scholarship money will be sent directly to the college or educational institution for the 2019 -
2020 academic year.
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For Committee use only:
__________Received on or before April 12, 2019
__________Application complete per requirements