The Edger C. Seitz Jr/Scott A. Seitz Endowed Scholarship Fund
Scholarships Awarded Will Be:
$1,000-$5,000
What are the guidelines?
An applicant must be:
¨ A Senior at LC or LN
(or a past recipient applying for renewal)
¨ In the top 1/3 of your class
¨ Majoring in a healthcare related field
(nursing, pre-med, physical therapy, physician’s assistant, etc.)
¨ An active participant in School,
Community and or Service Activities
¨ In need of some degree of
financial assistance
Due: March 27, 2008
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The Edger C. Seitz, Jr./Scott A. Seitz Endowed Scholarship Fund
Application Form
Recognizing Students Interested in a Healthcare Related Field
Application Deadline: March 27, 2008
Please return application to and nine copies to:
Lawrence Township School Foudation
5626 Lawton Loop E. Dr., Indianapolis, IN 46216.
317- 423-8300
I. Student Information
Student Name_______________________________________
Home Address_______________________________________
Social Security # ____________________________________
Home Phone_____________ E-mail Address______________
Date of Birth____________ Expected Graduation Date_______
Name and Address of College you plan to attend:
____________________________________________________
____________________________________________________
Intended Postsecondary Field of Study:___________________
___________________________________________________
II. Parent Information
Parent or Guardian Name____________________________
Address_________________________________________
Home Phone______________Work Phone_______________
Student Residing With:
___Father___Mother___Both___Other(_________)
Father’s Occupation___________________________________
Mother’s Occupation__________________________________
Number of Siblings__________Others in College?________
E-mail Address____________________________________
III. High School Data
All relevant information must be included, with appropriate signature, for
application to receive consideration.
G.P.A.______
Seventh Semester Rank _____ out of _____ Students
S.A.T. Scores : Verbal______ Math_______
A.C.T. Scores : _____ _____ _____ _____
Signature of Principal or Counselor____________________
Date__________
**Character Verification**
Please attach a written character reference from at least one classroom
teacher. (Length is not important.) No application will be considered
without this portion completed.
IV. Extra-Curricular Activities and Community Involvement
(Attach additional sheets, if desired)
A. High School (Scholastic Awards, Honors or Recognition)
__________________________________________
__________________________________________
__________________________________________
B. Extra-Curricular Activities
Name No. of Years Special Achievement
______________ _____ ________________
______________ _____ ________________
______________ _____ ________________
______________ _____ ________________
______________ _____ ________________
______________ _____ ________________
C. Community or Church/Synagogue Involvement
Name No. of Years Special Achievement
______________ _____ ________________
______________ _____ ________________
______________ _____ ________________
V. Need
Other Scholarships Rewarded &/or Received________
____________________________________________
____________________________________________
Please take the space provided and describe for the
committee your
financial need for this scholarship:____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
VI. Essay Statement
Attach a typed statement of 200 words or less about
your future goals and
Application and 9 copies must be submitted to Lawrenct Township School Foundation on or before Thursday, March 27, 2008.
In submitting this application I certify that the information provided is complete and accurate to the best of my knowledge. Falsification of information may result in termination of any scholarship granted.
Applicant's signature _____________________________________________ Date ______________________