Hendersonville Lodge No. 359 Scholarship
Free & Accepted Masons of Tennessee
Hendersonville, Tennessee

To assist a graduating high school senior from a Hendersonville area public school (Hendersonville, Beech, Station Camp, Merrol Hyde High Schools), chosen by Hendersonville Lodge #359, F&AM, according to the guidelines as recorded in the minutes of the Lodge and the attached Memorandum of Understanding.

Instructions: Complete the application by filling in ALL information. Incomplete applications will be rejected. All information contained in this application will be held in strict confidence. All applications must be completed by 11:59pm, February 28th, 2020.
Email address *
Name *
Your answer
Street Address *
Your answer
City, State, Zip *
Your answer
Home phone (include area code) *
Your answer
Cell phone (include area code) *
Your answer
email address *
Your answer
High School *
Name and contact information for your guidance counselor (email and phone number) *
Your answer
Name and contact information for one teacher reference (other than your counselor; email and phone number) *
Your answer
Name and contact information for one non-school reference (email and phone number) *
Your answer
College Entrance Exam score: ACT or SAT (combined score only) *
Your answer
Cumulative High School GPA (excluding current semester) on a 4.0 scale *
Your answer
List classes taken your Junior Year *
Your answer
List classes taken your Senior Year (indicate those currently being taken with a *) *
Your answer
List your career field objectives (ex. teacher, lawyer, nurse, attorney, minister, engineer, etc) *
Your answer
List the college, university, or educational institution you plan to attend *
Your answer
Total number of family members living at home: *
Your answer
Number of dependents in your parent's family (including you) *
Your answer
Ages of dependents in your parent's family (other than you) *
Your answer
Number of family members currently attending college/university *
Your answer
Indicate your family's adjusted GROSS income from last year's tax return: *
Other financial considerations which need to be noted?
Your answer
Organizations, clubs, and activities you are involved with (indicate years of affiliation and any offices held)
Your answer
Honors and Awards you have received
Your answer
List any community or other related activities with which you have been or are now involved
Your answer
Are you currently employed?
If yes to the previous question, with whom, what type of work do you do and how many hours per week are you employed?
Your answer
Describe any other work, social, community, or church activities of which you are involved that have not been described elsewhere on this application
Your answer
In your own words (not to exceed 150 words), please describe the course of study or the major field of interest which you plan to follow, your proposed occupation/profession, and any other abilities you have that you did not previously mention on this application.
Your answer
Do you have any relatives that are involved with the Freemasons?
If yes to the previous question, please list their names, lodge, city and state (if known)
Your answer
Memorandum of Understanding: Terms and Conditions 1. To be eligible for the receipt of the award, the recipient must carry at least the minimum number of credit hours per semester/quarter required to be considered a FULL-TIME student by the college/university (hereafter referred to as "institution"). 2. Scholarship monies will be forwarded to the institution that the recipient plans to attend upon notification from the aforementioned institution of acceptance of enrollments. 3. Should the recipient not complete the required courses or withdraw from the institution prior to the end of the session in which the recipient is enrolled, reimbursement IN FULL to the Hendersonville Lodge #359, Free and Accepted Masons, of ALL scholarship monies paid out in the recipient's name is expected. Exceptions to this clause will be as follows: a. Death of a family member that requires the recipient to attend to the immediate needs of the remaining family members before the end of the session; b. Illness of a family member that requires the recipient to attend to the immediate needs of the remaining family members before the end of the session; c. Illness of the recipient, caused by accident or disease, requiring hospitalization; or certification from the recipient's physician that the recipient is medically unable to complete the session. I hereby attest that I have read and fully understand the above terms and conditions and do hereby agree to said terms and conditions set forth to receive the Hendersonville Lodge Scholarship. A hard copy of this document must be signed by all parties and placed on file in the Lodge prior to the dispensing of any funds. By checking this box I agree to all of these terms and conditions and certify that the information provided is true and accurate. *
Required
Parent or Guardian's Name *
Your answer
Parent or Guardian's phone number *
Your answer
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