Seara Burton Memorial Scholarship Application.docx

Seara Burton FOP Auxiliary #63

PO Box 423 Richmond, IN 47375

FOPAux63@gmail.com

MEMORIAL SCHOLARSHIP APPLICATION

Please complete this application form in its entirety. Incomplete applications will not be considered.

Are you the child or grandchild of a current John W. Hennigar FOP Lodge #63 or Seara Burton FOP Auxiliary Lodge #63 member?

Scholarships will be awarded to both non-family members and family members.

Please circle one:

YES NO

If you answered YES to the above question, please provide the person’s name and your relationship to this person.

Last Name
First Name

Street Address
City, State, Zip

Telephone #
Email Address

Name of Parent / Guardian
Parent Email Address
Parent Telephone

School District
Class Rank	___________ out of ___________
GPA	___________ out of 4.0
Date of Expected Graduation
Date of Expected Graduation

Date of Expected Post-Secondary Entrance
Name / City / State
of College,
University,
Vocational School
you plan to attend

Select One 🡪	____ Accepted _____ Applied/Pending _____ Enrolled
Field of Study / Planned Major

Give details
regarding other
scholarships,
Grants, awards
you are seeking

Indicate, if
applicable, any
family or personal
circumstances that
make you a strong
candidate for this
award:

Extra-Curricular
Activities while in
High School



Awards and / or
Honors Received
in High School



Employment	Employer _____________________ Date of Employment _______________________
History during	Job Title ______________________ Supervisor’s Name ________________________
High School
	Employer _____________________ Date of Employment _______________________
	Job Title ______________________ Supervisor’s Name ________________________

	Employer _____________________ Date of Employment _______________________
	Job Title ______________________ Supervisor’s Name ________________________

How will your
Post-Secondary	Please attach your response in the form of an essay approximately 200 words,
Education	typewritten, double-spaced.
Benefit You as an
Individual



How will your
Post-Secondary	Please attach your response in the form of an essay approximately 200 words,
Education	typewritten, double-spaced.
Benefit Your
Community




Provide an
example of	Please attach your response in the form of an essay approximately 200 words,
something you	typewritten, double-spaced.
have done for the
betterment of your
school or
community. Chose
something that
demonstrates
your character.

Acknowledgement and Scholarship Release Statement:

By signing and dating below, I acknowledge that the information provided in the above application is correct to the best of my knowledge and confirm that I satisfy all the criteria for the Seara Burton FOP Auxiliary #63 Scholarship for which I am applying. Furthermore, if I am selected for a scholarship award, I authorize the Seara Burton FOP Auxiliary #63 to release my name, hometown, high school, post-secondary school, and major to the public.

Applicant Signature: Date:

Parent / Guardian Signature: Date:

Attachments:

Official transcript from your high school.

Two letters of recommendation from people other than family members who are familiar with your contributions and character. Examples include your teacher (only one), pastor, guidance counselor, coach, employer, neighbor, etc.

Three short essays from application.

Completed and signed application.

Once all attachments are collected and application is completed, please mail to the following address:

Seara Burton FOP Auxiliary #63

Attn: Scholarship Committee

PO Box 423

Richmond, Indiana 47375

Application must be postmarked by April 5th, 2024 to be considered for scholarship.