Norbert L. Gazin Education Fund Application for Scholarship
Please submit the attached application to the Guidance Office
by March 23, 2012.
* NO LATE OR INCOMPLETE APPLICATIONS WILL BE CONSIDERED. It is the
student's responsibility to make sure all parts of the application are in by the deadline date.
1. Applicant must:
a. Be born in Lewis County OR parents resided in Lewis County at the time of
b. Be a resident of Lewis County for at least five (5) years prior to application.
c. Be a graduate (or will be a graduate) of a Lewis County High School.
d. Have no felony convictions.
e. Be enrolling or enrolled in a full-time college program.
2. PRIORITY will be given to eligible applicants enrolling or enrolled in schools of:
3. a. High School Applicants who are not declaring one of the priority majors should
have a minimum of an 80 G.P.A. to apply for the Gazin Scholarship.
b. High School Applicants who are declaring PRIORITY (engineering, agriculture,
or forestry) major must have a minimum of a 70 G.P.A. to apply for the Gazin
c. Alumni may apply for the Gazin Scholarship each year however; they should
have a minimum of a 2.5 cumulative G.P.A. and submit the most recent
transcript (Fall 2012).
d. Graduate students may apply for the Gazin Scholarship if they qualify for the
priority majors only: engineering, agriculture, or forestry and have a minimum
G.P.A. of 3.0.
The Gazin Scholarship is becoming more competitive each year. A minimum G.P.A. criteria
has been established to apply, however, the committee reserves the right to determine
winners each year to maintain the integrity of the scholarship. Winners will be notified by
July 1, 2011.
*Attach to your application:
___ Complete high school transcript (for high school students) or
Complete college transcript w/cumulative GPA (for college students)
___ Copy of your birth certificate (new applicants only)
___ Copy of college acceptance letter (for high school students)
(Current college students who are submitting college transcripts DO NOT
have to attach acceptance letter.)
NORBERT L. GAZIN EDUCATIONAL FUND SCHOLARSHIP APPLICATION
Information to be completed by STUDENT (Please Print or Type)
Student’s Name: High School
DOB: _ Social Security #: Telephone #:
Cumulative G.P.A. _________ Date of High School Graduation_________
Have you ever been convicted of a felony? Yes _____ No_____ (If yes, you are not eligible.)
Were your parents residing in Lewis County at the time of your birth? Yes _____ No ______
(If no, you are not eligible.)
resided in Lewis County for at least five (5) years? Yes_____ No ______ (If no, you are not eligible.)
Name of college/trade school you expect to attend
Address: _________________ City: ____________________ State: _________ Zip: ____________
Have you been accepted? Yes _____ No _____ (if yes, attach copy of acceptance letter)
Major course of study/trade
Anticipated date of program completion_________ Full-Time _____(If not full time, you are not eligible.)
Have you previously received this award? Yes _____ No _____
If so, please state the date(s) of award: ________________________________________________
Everything that I have stated in this application is correct to the best of my knowledge. I
understand that you will retain this application whether or not it is approved.
Student’s Signature Date
WORK EXPERIENCE: (Part-time, full-time or vacation, paid or volunteer)
Employer Employer’s Address Title Start End Date
SCHOOL & EXTRACURRICULAR ACTIVITIES:
List all school organizations, major activities, honors and offices held.
List out-of-school organizations, memberships and offices held.
List hobbies, recreation and sport activities.
Please type and attach or neatly hand write a paragraph
on your anticipated career and why you have chosen it.
Information to be completed PARENT (Please print or Type)
Information regarding applicant’s family:
Father, Stepfather, Guardian (circle one) Mother, Stepmother, Guardian (circle one)
List brothers and sisters in household, including names, ages and year in school.