The Lebanon American Club

of Danbury, Connecticut, Inc.

22 WEST STREET, DANBURY, CONNECTICUT 06810

SCHOLARSHIP CANDIDATE APPLICATION

STUDENTS NAME:_________________________________________________________________
ADDRESS: ________________________________________________________________________
TELEPHONE:__________________________ EMAIL: _____________________________________
MEMBER'S NAME: _________________________________________________________________
MOTHER'S NAME: _________________________________________________________________
HIGH SCHOOL: ___________________________________________________________________
Please provide your high school and community experiences by completing this form (using additional
pages as necessary) and return along with 2 photographs (digital format prefered) suitable for repriting in
local newspaper and Dinner program book no later than Monday May 11, 2015:
You may submit your application and photographs via email: mark.chory@snet.net
Or via U.S Mail to:

Mark Chory, Co-Chair

Lebanon Club Scholarship Committee
c/o 23 Judith Street
Danbury, CT 06811

Please have your guidance counselor submit a copy of your transcript and two letters of recommendation
to the email or address above No later than Monday May 11th. Even if your transcripts are not
available by the deadline please submit your otherwise completed application by the deadline. Contact
Mark Chory at (203) 240-0731 with any questions.
SCHOOL ACTIVITIES: (clubs, student government, music & stage productions and sports etc.)
AWARDS/RECOGNITIONS RECEIVED:
COMMUNITY INVOLVEMENT:
WORK EXPERIENCES:
HOBBIES:
FUTURE ACADEMIC PURSUIT:
ESSAY: Using a separate page in 150-200 words state the significance or special meaning receiving a
scholarship from the Lebanon-American Club has for you.