Scholarship Application

Please fill out the information below to submit your application.

Name of ApplicantPhone NumberAddressDate of BirthEmail Address

College or University Where You Expect to Use the Scholarship:Address of SchoolGrade or Year in College Next Semester or Quarter

Father's NameFather's OccupationFather's AddressMother's NameMother's OccupationMother's Address

Are You Married?

If You Are a Minor and Have a Legal Guardian, Give Name of Gaurdian:Guardian's Address (If Applicable)

Are You a Member of an Odd Fellow or Rebekah Lodge?Lodge Information to which You or a Relative BelongsRelative's NameRelative isDate of Relative's Initiation to an Odd Fellow or Rebekah Lodge:Relationship of Relative to ApplicantName of Lodge SecretaryAddress of Lodge Secretary

Are You Receiving or Expect to Receive any Other Scholarships, Fellowships, Grants, Bursaries (Canada), or Other Student Aid?If So, Please List Each with the Amount Below

Do You Receive Social Security Benefits?Do You Receive Veteran Administration Benefits?Do You Receive G.I. Bill Benefits?Do You Receive Trust Fund Payments?If You Answered Yes to Any of the Above (Social Security, Veteran Administration, G.I. Bill, Trust Fund Payments), Indicate Source and Periodic Amount Below

Please list in the space below your most significant extracurricular and community activities (excluding jobs) during the past 3 to 4 years in order of their interest to you. Examples: Student government, school service clubs & honor societies, dramatics, athletics, music, boy or girl scouting, 4H club, religious activities, summer camps, travel, etc. Since part of this scholarship criteria is based on leadership, it is extremely important to indicate leadership positions and honors received. Please provide a statement in the box below which describes your need for financial assistance to continue in school.

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Address

Jackson Lodge #8
37 E. Deloney Ave
PO Box 586
Jackson, WY 83001

307-413-1839

jacksonoddfellows@hotmail.com

Meeting hours

We meet 2nd Wednesday Every Month, 6:30pm