Scholarship ApplicationPlease complete in typed or word processor format only.

Student’s Full Name:____________________________________

Student’s Address:______________________________________

Date & Place of Birth:____________________________________

Parents or Guardians:___________________________________

Cumulative GPA:_______________________________________

Please use additional paper to answer the following in typed format:

1) For which grades (1 through 12) have you attended Lopez School?

2) Please chronicle your extracurricular school involvement and community service. (For example, Football – 8, 9, 10, 12th grades, Volunteer at Senior Center lunches 12th grade, Volunteer at Fun Run 11th grade).

3) List employment position(s) held, length of time worked and give name(s) of employers.

4) State your plans for enrollment in an accredited trade school, college, or university. What is your proposed field of study?

5) How could the school and community have improved your Lopez School education experience?

6) If you could, what would you change in your high school experience?

File:Scholarship rev 03/26/15 Rev: 4/1/2015 4:31 AM

352 Lopez RoadPO Box 190Lopez Island, Washington 98261(360) 468-2616

Lopez Island PharmacyRichard C. McCoy, Jr.

PharmacistMargaret A. McCoy

Pharmacist