LOCAL SCHOLARSHIP APPLICATION
P.O. BOX 5019
FORT MYERS BEACH, FL 33932
CHECK ONE_____ I AM APPLYING FOR THE FRED ROBINSON MEMORIAL SCHOLARSHIP FOR ARTS STUDIES
_____ I AM APPLYING FOR ONE OF THE 4 GENERAL BEACH LIONS SCHOLARSHIPS
PERSONAL DATA:
LAST NAME _____________________________________________________________________________________________
FIRST NAME ____________________________________________MIDDLE NAME__________________________________________
ADDRESS: _______________________________________________________________________________________________
CITY ______________________________________________ STATE ______________________ ZIP ___________________
TELEPHONE ______________________________ EMAIL _________________________________________________________
SCORES:
SAT _____________ ACT _____________ GPA _____________ CLASS RANK ________
EDUCATIONAL GOALS:
VOC TECH TWO YEAR COLLEGE FOUR YEAR COLEGE _____________________________________________________________
SCHOOL CHOICE ONE ________________________________________________________________________________________
SCHOOL CHOICE TWO ________________________________________________________________________________________
SCHOOL CHOICE THREE ______________________________________________________________________________________
MAJOR ____________________________________________________________________________________________________
CAREER GOALS: ____________________________________________________________________________________________
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INTEREST IN SORORITY OR FRATERNITY:
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FAMILY INFORMATION:
FATHER’S NAME _________________________________________________________ OCCUPATION _________________________MOTHER’S NAME _________________________________________________________ OCCUPATION _________________________
STUDENT LIVES WITH: ____________________________________________________________________
NUMBER OF SIBLINGS AT HOME _______________ NUMBER OF SIBLINGS IN COLLEGE ________________________________
WORK EXPERIENCE: _____________________________________________________________________________________________
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OTHER: _______________________________________________________________________________________________________
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STUDENT ACTIVITIES: List student activities in which you have participated during grades 9-12 and the appropriate grade level. List leadership position held and accomplishments and the grade level.
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COMMUNITY/CHURCH-RELATED ACTIVITIES: List all community service, non-scholastic volunteer work, and clubs or interests outside of school.
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SPECIAL RECOGNITIONS, REWARDS AND HONORS: List commendations not previously listed.
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APPROXIMATE YEARLY FINANCIAL NEEDS:
TUITION (SCHOOL CHOICE ONE) ________________________ ROOM AND BOARD _______________ BOOKS AND SUPPLIES _______
TUITION (SCHOOL CHOICE TWO) ________________________ ROOM AND BOARD _______________ BOOKS AND SUPPLIES _______
PERSONAL STATEMENT: Please describe your reasons and needs for scholarship aid. Include any unusual circumstances. If you need additional space, you may add extra pages.
SIGNATURE: My signature below indicates that all the information contained in this application is complete, factually correct, and honestly presented. I also hereby grant permission to give this form and my academic records to the necessary personnel to be reviewed for awards and/or scholarships.
STUDENT’S SIGNATURE _______________________________________________________ DATE ___________________ Lion DARBY DOERZBACHER
PARENT/GUARDIAN SIGNATURE ________________________________________________ DATE ___________________
INSTRUCTIONS: MAIL COMPLETED APPLICATION WITH OPTIONAL PHOTO ATTACHED TO:
11270 HEIDI LEE LANE
FORT MYERS, FL 33908
APPLICATIONS MUST BE RECEIVED BY MAY 31, 2011
BEACH
SCHOLARSHIP WINNERS! LIONS AWARD SCHOLARSHIPS
SCHOLARSHIP WINNER!
The Fort Myers Beach Lions Foundation presented the winners of the 2009 "WE SERVE" Scholarship with their checks at the regular dinner meeting on July 23 at St. Raphael’s Parrish Hall. Kira Dobbs, Rachel Mielke, Jessica Libak, William Dean Simmons & Bryan Mayer each received $1000.00 checks to assist in their college education. The "WE SERVE" Scholarship is awarded annually to deserving students who wish to further their education. Applications will be available in the spring for next year’s contestants. The Lions meet at the Parrish Hall on Williams Drive the 2nd and 4th Thursdays of each month at 7PM. Call Lion President Patsy Dorsey at 239-463-1027 or log on to fmblions.com for more information. Proceeds of Lions Activities such as the annual Fort Myers Beach Shrimp Festival Weekend help fund these scholarships and many more local needs. For information about joining the Lions call Jerry at 765-5478 or e mail to info@fmblions.com.
