2025 LHSCA SCHOLARSHIP NOMINATION FORM

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STUDENT'S NAME *

HIGH SCHOOL *

HOME ADDRESS *

HOME OR CELL PHONE *

STUDENT'S EMAIL ADDRESS *

DATE OF BIRTH *

YYYY

GENDER *

GRADUATION DATE *

CUMULATIVE GPA (UNWEIGHTED) *

CLASS RANK *

HIGHEST ACT/SAT SCORE *

LIST OF ALL HONORS / AP COURSES TAKEN OR CURRENTLY ENROLLED IN *

WHAT (IF ANY) FINANCIAL AID/SCHOLARSHIPS WILL STUDENT RECEIVE *

HIGH SCHOOL SPORTS & GRADE LEVEL PARTICIPATED IN *

HIGH SCHOOL EXTRACURRICULARS & ORGANIZATIONS *

HIGH SCHOOL ATHLETIC & EXTRACURRICULAR HONORS *

COMMUNTY SERVICE INVOLVEMENT *

UNIVERSITY or COLLEGE ATTENDING *

ANTICIPATED MAJOR *

POST-COLLEGE & CAREER PLANS *

MOTHER'S NAME *

MOTHER'S CONTACT NUMBER *

MOTHER'S EMAIL ADDRESS *

MOTHER'S OCCUPATION *

FATHER'S NAME *

FATHER'S CONTACT NUMBER *

FATHER'S EMAIL ADDRESS *

FATHER'S OCCUPATION *

BROTHERS/SISTERS CURRENTLY ENROLLED IN SCHOOL *

NAME OF PARENT THAT IS AN LHSCA MEMBER & SCHOOL

YEARS OF LHSCA MEMBERSHIP *

PLEASE STATE WHY YOU ARE DESERVING OF AN LHSCA SCHOLARSHIP *

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