Qualifications for the Loyal Order of Moose #1483 Scholarship Program: The applicant must be a high school graduate




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BERKELEY SPRINGS LODGE #1483

LOYAL ORDER OF MOOSE
COLLEGE SCHOLARSHIP PROGRAM
The following are guidelines regarding qualifications for the Loyal Order of Moose #1483 Scholarship Program:


  1. The applicant must be a high school graduate.




  1. Applicants must be recommended by high school principal and guidance counselor and have made a satisfactory score on the American College Test (ACT).




  1. Student must have maintained a 2.0 average in high school.




  1. Amount of scholarship shall be $500.00 for a one-year period only.




  1. The student must agree to repay $250.00 if, for any reason, the student does not complete the first year of schooling.




  1. Deadline—April 25th



  1. Applicant’s Name


Address Phone #
Physical Health  Poor  Fair  Good  Excellent


  1. Date of Birth Birthplace


US Citizen:  Yes  No


  1. Parents/Guardian: Father Mother


Address Phone #
Sisters & Brothers (list names and ages)



  1. Occupations: Father Mother




  1. Can you meet other expenses outside your scholarship?  Yes  No




  1. Educational Background: High School


Grade Point Average Rank in Class


  1. Planned Further Education:


Type of School:  College  Business College  Other
Trade School  Technical School  Vocational School
Name of School ACT Score (composite)
Proposed Major Minor


  1. Other Information:




    1. Do you feel that you will complete your schooling?




    1. Why are you applying for a Loyal Order of Moose Scholarship?





    1. If granted the Loyal Order of Moose Scholarship, would you agree to use the money only for the purpose of paying expenses for your schooling?




    1. If for any reason you do not complete your first year of schooling (for which this scholarship is granted), would you agree to repay one-half of the amount of the scholarship granted?  Yes  No




Signature of Applicant


  1. Character References: (Do not use relatives) (List names & addresses)

















I hereby declare that to the best of my knowledge and belief the information given in this application is correct.
Date Signature of Applicant
Date Signature of Parent/Guardian
Please return to Ms. Pennington by April 25th


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