Brookfields' Lions Club

P.O. Box 188          North Brookfield, MA 01535

Scholarship Application

Student Name __________________________________________

Address City ___________________________________________

Tele: No. _________________________

High School Rank ________

*Guidance Director Signature ______________________________

Father Occupation ____________________

Mother Occupation ____________________

Age of Brothers/Sisters ______

(Attending College ?)________

What College Do You Plan To Attend?________________________

Have You Been Accepted? ______

Have You Received Any Scholarships? ______

Career Seeking __________________________________________

* Guidance Director Must Sign This Application

 
 
     
 
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