Bill Lent Memorial Scholarship Application

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					                           Bill Lent Memorial Scholarship Application

DIRECTIONS: Please fill in all of the information requested as completely as you can. This
application must be returned to Bob Fawcett. 2626 Sandusky Street, Zanesfield OH 43360
Email: No later than May 7, 2010. Please type or print the
information neatly.

My name is
                 First            Middle               Last

I live at
                 Address                   City                  State            Zip


Email address:

My parents (or guardians) names are:

I am presently a senior at                             High School.

My cumulative class rank is      out of    members in my class and my cumulative grade point
average is       .

The courses I am taking during the second semester of my senior year are:

I have participated in the following school activities (note offices held):
(You may attach a list if necessary)

I have participated in the following community and/or work activities during the last four years:

I have been accepted to, and plan to attend                      , where I plan
                                                  Name of institution
to major in                 .

The approximate total cost (tuition, room, board) of one year’s work at my school is                .

My family’s combined 2009 adjusted gross income is                  . (Note: This must include
the family with whom you reside most of the year, including a step-parent if applicable.)

Please list any special circumstances which have or will affect your family’s income (i.e. large
medical bills, loss of income, etc.)

My father works at                                                                              as a
                                Place of employment                                                           Occupation

My mother works at                                                                              as a
                                Place of employment                                                            Occupation

There are         total dependents in my family. (use the number claimed on income tax forms).

There will be         members of our family attending college next year.

To the best of my knowledge, all of the information in this application is accurate.

                                Applicant’s Signature                                    Date

                                Parent’s Signature                                       Date

Bill’s mother, brother and sister will select the recipient of the these scholarships.

The awardees(s) of this scholarship will be notified by May 19th, 2010 and the recipient’s name will be posted on the
various Club volleyball websites.

The Lent Foundation Committee