application

Scholarship Application for
The Leslie Wellman Larsen Memorial Scholarship Fund

Name of Student ______________________________________________Cumulative GPA______________

Permanent Address ____________________________________________Phone Number _______________

College/University You Attend _______________________________________________________________

Due Date of Semester Fees _________________

If you are awarded this scholarship, the Scholarship Committee would like to send an article to your local newspaper. Please note the newspaper's
                              NAME __________________________________________________________

                              ADDRESS_______________________________________________________

                              ATTENTION_____________________________________________________

(Completion of the above section is an agreement to allow the Scholarship Committee to use information from your application for publicity releases. Your qualification for this award is not determined by completion of this section).

1.   Scholarship application (this page)

2.   Letter from college/university showing acceptance to the Education Department.
      Proof of major must be indicated on transcript.

3.   College/University transcript showing courses taken + GPA

4.   Photocopy of birth certificate or naturalization papers. NOTE: Applicants of members of
      NSDAR or NSSAR must give the mother's or father' name, National Number , and name
      and address of which Chapter the parent is a member, if applicable.

5.   Applicant must submit an essay setting forth his/her career objectives, specifying how and
      why this relates to future professional goals and reasons for these choices.

6.   Applicant must submit a short high school and college biography stating extra curricular
      activities, honors received, scholastic achiements, hobbies and other significant accomplishments.

7.   Dated, sighned letters of recommendations from at least two persons (non-relatives)
      who are familiar with your work, character and ideals. (Letter may cover applicant's ability,
      work habits, integrity and potential.)

DO NOT SEND PHOTOS

Mail to:                Libby Bentson
                            Scholarship Chairman
                            517 Oak Alley
                            Pearl River, LA 70452

In order to acknowledge the receipt of application you must include a self-addressed, stamped postcard.