Lake County Retired Teachers Association Scholarship

Application Form

PLEASE PRINT ALL INFORMATION REQUESTED                   DATE _________________


Name ____________________________________ Home Phone ___________________

Address _________________________________________________________________

            _________________________________________________________________

Parent and/or Guardian's Name: ______________________________________________

High School __________________________ Counselor ___________________________

Class Rank ________ OUT OF ________ G.P.A. (on a 4.0 scale) ________

Test scores if available:    ACT Score _____ SAT Verbal Score _____ Math Score _____

FINANCIAL NEED INFORMATION:

Household Composition:      Number of Adults: ______ Children: ______

Number of household members enrolled or to be enrolled in college, including applicant: ____

Total taxable income from previous tax year as reported on Federal Income Tax forms.
(Include all members of the household):
____ 0 - $20,000____ $20,000 - $40,000
____ $40,000 - $75,000____ $75,000 and over

Please indicate below the source and amount of any financial aid you expect to receive other than this scholarship:

_____________________________________________________________________

_____________________________________________________________________

On a separate sheet of paper, please list your high school and community involvement:
(work experience, volunteer work, clubs, sports, honors, activities, awards, etc.)

On a separate sheet of paper, include a one page essay telling us why you want to be a teacher, where you plan to go to school, your intended major field of study, your goals for the future, and why you feel you qualify for this scholarship.

Please remember to attach two letters of recommendation and your high school transcript to this application.

Either print this form out and fill in OR Click here to download this form in a Word document to save to your computer and type the information requested.