Mountain View Odd Fellows Lodge No. 244
Mountain View Odd fellows Lodge No. 244 Application for Scholarship
Name: ________________________________________________Phone Number: (________)__________________
Address: _____________________________________________________________________________________
School:_______________________________________________________________________________________
Father’s Name: ___________________________________________________________
Occupation Where Employed: _________________________________________________
Mother’s Name: ___________________________________________________________
Occupation Where Employed: _________________________________________________
Are your parents Married or Divorced: ____________________________________________
Is either one or both of your parents deceased? Father: ____ Mother: ____
Are You Supported by Both Parents? Yes____ No____
If Answered “No” Please specify who your Primary Source or Support is:
Mother: _____ Father: _____ Other: ______________________________________________________
Ages of Brothers and Sisters: ____________________________________________________________________________
What College Do You Plan To Attend? List in order of preference: _________________________________________________
___________________________________________________________________________________________________
Have You Applied For Other Scholarships? Yes_____
List Your School Activities: Clubs, Honors, Awards, etc.: ________________________________________________________
____________________________________________________________________________________________________
Outside of School Activities and Jobs Held: __________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Page 1
