Name_______________________________________ Social Security No.______________________________
        Address_______________________________________________________Phone No.____________________
                 street            City/State/Zip
        High School________________________________________________________________________________
                     Name         street         City/State/Zip
        Year and Month will graduate from high school___________________________________________________
        College/University/Vocational School planning to attend:
        _________________________________________________________________________________________
             Name             Street                     City/State/Zip
         Educational Goal (give name of major study)_____________________________________________________
        I will receive a Certificate of____________________    or a ________________________________ Degree.
        Employment Record (Employer, address, dates of employment, person to contact)
        ________________________________________________________________________________________
        _______________________________________________________________________________________
        _______________________________________________________________________________________
        _______________________________________________________________________________________
        Activities (School, Church, Civic)
        _______________________________________________________________________________________
        _______________________________________________________________________________________
        _______________________________________________________________________________________

         Applicant's Signature___________________________________________________ Date_____________
         Application must be filed with the Elks Lodge in the area in which the applicant resides on or before March 20.
        Lodge Name and No._____________________________________ Signed___________________________
                                            Youth Activities Chairman

SEE OTHER SIDE FOR INSTRUCTIONS -- READ AND FOLLOW CAREFULLY.

    1.    1.    APPLICATION: Applicant must use a Utah Elks Association scholarship form. Typewritten applications, statements, and letters are preferred over handwritten submissions and must be signed and dated in all instances. Applications and all supporting documents (exhibits) must be in English or English translation and must be legible. Letters must be originals on one side of 8-1/2 x I I inch paper, signed and dated by the author.

2.     EXHIBITS: Should be neat and concise. Letters, etc., should be removed from envelopes and bound flat. Originals of certificates, awards and other printed material should not be submitted.

3.     REQUIREMENTS AND ORDER:
    A.    Application -- legibly completed, signed by the applicant and dated.

    B.    A statement by the applicant, of not more than 300 words, covering;
            WHERE I HAVE BEEN.
            WHERE I AM.
            WHERE I WANT TO GO.
        Statement must be signed by the applicant and dated.

    C.     A letter from a parent, guardian, or other responsible adult (i.e., social worker, older sibling, or other relative) stating why the author of the letter has confidence in the applicant to successfully reach his or her goals, and the willingness of the author to provide moral support to the applicant in his or her future endeavors.
    D.     A letter from a responsible person from the Alternative High School the applicant is presently attending stating that the applicant, on a specific date, will graduate from high school. Also include in the letter an assessment of the applicants ability and comniitinent to attain their educational goals.
    E.     A letter from a responsible person, other than a relative or educator, (i.e., employer, social worker, church or civic leader, etc.) who can give an opinion, based on personal observation, on the applicants character and acceptance of responsibility.
    F.     Applicants High School grade transcript (9th through 12th grades (must include at least fwst half of 12th grade)).
    G.     Other Exhibits, additional letters, copies of certificates, awards, and other printed material, any other information which the applicant feels would be helpful in judging his or her worthiness for this scholarship.
    NOTE: Exhibits 3A through 3F must be submitted. Application and Exhibits must not exceed 15 pages.

4.    All applications must be properly bound on the left-hand side (allow sufficient margin on left side to provide for readability). Elaborate bindings or bulky covers should not be used.