LANSING OLD TIMERS

Scholarship Program Application for 2012

3 Easy Steps to apply for a scholarship

DATE

1

Print this form

2

Fill in ALL sections on form

note: application deadline is May 1, 2012

3

Mail form to L.O.T / FRANK KIEFOR BOX 133 LANSING IL 60438

APPLICANT NAME

ADDRESS

CITY

STATE

ZIP

PHONE

Please fill out all sections below:        NOTE: ATTACH OFFICIAL H.S. TRANSCRIPT

HIGH SCHOOL

GRADUATING CLASS OF:

CLASS RANK

OF

LATEST GPA:

or

on

Letter Grade

Numeric Grade

Scale

VERIFIED GPA:

signature of high school official required

COLLEGE

Date Applied

NOTE: Attach acceptance letter or proof of

Date Accepted

enrollment if available. If not available, proof

will be required before grant is awarded.

LANSING OLD TIMERS

Scholarship Program Application

note: application deadline is May 1, 2012

LIST THE SPORTS YOU PARTICIPATED IN DURING YOUR HIGH SCHOOL CAREER

CARREER TO EACH YEAR.

FRESHMAN:

SOPHMORE:

JUNIOR:

SENIOR:

VERIFIED PARTICIPATION:

signature of high school official required

LIST THE OLD TIMER PROGRAM PARTICIPATION AND NUMBER OF YEARS IN EACH:.

Little League

Football

Girls Softball

Babe Ruth

Cheerleader

Volleyball

LIST ANY PARENT OR GUARDIAN THAT COACHED, MANAGED, BOARD MEMBER,

OR WAS A MEMBER OF THE LANSING OLD TIMERS MEMBER IN GOOD STANDING.

PLEASE PROVIDE NUMBER OF YEARS:

APPLICANTS SIGNATURE

DATE

PARENT/GUARDIAN SIGNATURE