Mailina address

NOTTION SOND

Tast Name

Dhano Mumhor

Hiah School Attended

LEANDER

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First Name

Middle Name (or

Zio Code

Date of Rirth

Email Addrocc

Gender ( M/F)

US Citizen

## Scholarship Application Norton Moses Masonic Lodge, #336 $1000 Scholarship Award

Last Name

First Name

Middle Name (or Initial)

Mailing address

City

Zip Code

Phone Number

Date of Birth

Email Address

High School Attended

Gender ( M/F)

US Citizen

## Eligibility and Requirements

1. Be a graduating senior from any LISD High School
2. Complete and sign this form, including signature of H.S. Counselor or Principal
3. Attach a copy of your High School transcript to this application
4. Attach a double spaced, 750-word essay on the
5. following selected topic:a. The Contributions of Freemasonry in Texas History
6. I hereby grant permission for my essay to be used in Masonic publications
7. I hereby authorize Leander ISD to make available to Norton Moses Lodge Scholarship committee information concerning my academic records

## Counselor or Principal's Certification

I hereby certify that the academic information and summary of school activities as submitted are true and correct to the best of my knowledge

## Applicant's Certification

I hereby certify that the academic information and summary of school activities as submitted are true and correct to the best of my knowledge. I understand that submitting false information will automatically disqualify me from consideration for a scholarship.

Counselor or Principal Signature and Date

Student Applicant Signature and Date

Name of College or University in order of

Date

Norton Moses Masonic Lodge Scholarship Committee PO Box 586 Leander TX 78646

Date

Citv

| preference | Applied | Accepted |
| ---------- | ------- | -------- |

High School Sponsored Activities (Clubs, Athletics, Band, JROTC, Etc)

| Name | Yr 09 | Yr 10 | Yr 11 | Yr 12 | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned | Description of how honor was earned |
| ---- | ----- | ----- | ----- | ----- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- | ----------------------------------- |

Academic Honors or Other Achievements

| Name | Yr 09 | Yr 10 | Yr 11 | Yr 12 | Description of how honor was earned |
| ---- | ----- | ----- | ----- | ----- | ----------------------------------- |

Employment

| Name | Yr 09 | Yr 10 | Yr 11 | Yr 12 | Average Hours per Week/per Year | Average Hours per Week/per Year | Average Hours per Week/per Year | Average Hours per Week/per Year | Average Hours per Week/per Year | Average Hours per Week/per Year |
| ---- | ----- | ----- | ----- | ----- | ------------------------------- | ------------------------------- | ------------------------------- | ------------------------------- | ------------------------------- | ------------------------------- |

Community Activities

| Scouts, DeMolay, Rainbow Religious Etc. | Yr 09 | Yr 10 | Yr 11 | Yr 12 | Average Hours per Week/per Year |
| --------------------------------------- | ----- | ----- | ----- | ----- | ------------------------------- |

Scholarship Application Deadline is April 15 th 2020

Norton Moses Masonic Lodge Scholarship Committee PO Box 586 Leander TX 78646
