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GENERAL INFORMATION

Date *

Student's First Name *

Student's Last Name *

High School *

School Classification *

Street Address

City

State / Province / Region

Postal / Zip Code

Country

Home or Mobile Phone *

Student's Email *

Date of Birth *

Gender *

ACADEMIC INFORMATION

Graduation Date *

Cummulative GPA (Unweighted) *

Class Rank *

Carnegie Units Eared *

Highest ACT/SAT Score *

ACT/SAT Testing Date *

List all honors courses taken and current enrolled *

What (if any) scholarships/financial aid student has or will receive? *

ATHLETICS & ACTIVITIES

High School Sports & Grade Level Played *

Non-Athletic High School Organizations & Activities *

Athletic & Non-Athletic High School Honors *

Community Service *

Hobbies *

POST GRADUATE PLANS

University/College *

University/College Location *

Intended Major *

Intended Minor (If Applicable)

Post College & Career Plans *

Mothers's Information

Mother's First Name *

Mother's Last Name *

Street Address

City

State / Province / Region

Postal / Zip Code

Country

Mother's Contact Number *

Mother's Email Address

Occupation *

Employer *

Father's Information

Father's First Name *

Father's Last Name *

Street Address

City

State / Province / Region

Postal / Zip Code

Country

Father's Contact Number *

Father's Email

Occupation *

Employer *

Children currently enrolled in school *

LHSCA MEMBERSHIP INFORMATION

Name of parent that is an LHSCA Member *

Current School *

Parish *

Years of LHSCA Membership *

Membership Dates *

Is the LHSCA Member retired? *

Is the LHSCA Member deceased? *

STUDENT STATEMENT

Please state why you are deserving of an LHSCA Scholarship. *

As a student-athlete, I hereby state, that to the best of my knowledge, the information provided in this application is accurate.

Signify the above statement by typing your name below.

First Name *

Last Name *

Date *

Official Transcript *

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