WOMEN IN LONGVIEW, INC.

P.O. Box 161

Longview, TX 75606

2012

SCHOLARSHIP APPLICATION

Women In Longview, Inc. will award a $1,000 scholarship to an adult woman who wishes to continue her education. The recipient will have either a high school diploma or a GED and be interested in pursuing a field of study at an accredited college, university, technical, or vocational school. Financial need, community involvement, and letters of recommendation will also be given consideration. Applicants must be U.S. citizens. Applications are due February 24, 2012.

Please complete all areas in their entirety. Print or type your responses and return the application with required documents to: Women In Longview, Inc., Scholarship Committee, P.O. Box 161 Longview, TX 75606.

NAME:______________________________________________________ DOB: ___________

MAILING ADDRESS: __________________________________________________________

CITY: _____________________ STATE: ______________ ZIP:______________

CONTACT PHONE NUMBERS: (HOME) _____________ (WORK) ____________ (CELL) ________

Are you employed? ________________________

Where and for how long? _________________________________________________________

Describe your educational background: ______________________________________________

When and from where did you graduate from high school, receive a GED, or obtain a higher degree? _________

Name ____________________

What work or community activities have you participated in since that time?

Describe your goals.

Name ________________

Why can we expect you to attain your goals?

Explain your need for financial assistance.

CERTIFICATION:

I certify that all information in my application packet is correct to the best of my knowledge.

MEDIA RELEASE:

If I am the recipient of a Women in Longview, Inc. scholarship, you may release my name and information about me to the media and be included on the Women in Longview, Inc. website.
____ YES _____ NO

Applicant’s Signature: ____________________________________ Date __________________