Full Name:___________________________________ Permanent Phone:____________________________
Permanent Address:_________________________________________________________________________
_______________________________________________________________________________________
List your lineal
ancestor(s) who attended Canton Lincoln Junior or Senior High School,
the years they attended, and your relationship to them. (PLEASE NOTE:
At least one of the ancestors you list must be a paid
member for the current
year and must have their membership ($10)
postmarked no later than the scholarship application deadline
(March 15th) before your application will be considered. If your
ONLY lineal Lincoln ancestor is deceased, please
note; the paid membership requirement is waived.)
Relationship: Ancestor's Name: (Include Maiden Name If Applicable Years Attended:
Self ______ ____________________________________________ 19 __ -19__
Mother ______ ____________________________________________ 19 __ -19__
Father ______ ____________________________________________ 19 __ -19__
Grandmother ______ _______________________________________ 19 __ -19__
Grandfather
______
_____________________________________
19 __ -19__
Name the high school you currently attend, most recently attended, or from which you graduated:
School:__________________________________________________________
Location:________________________________________________________
High school graduation date:________________________________________
Date G.E.D. received:_________________________(If
you received
a G.E.D., please provide a photocopy of it.)
Name of the accredited school you plan to attend:
School:_____________________________________________________________________________
School's Address:_____________________________________________________________________
Have you been accepted at that school?
______________ Beginning
Date:____________________
Have you ever received a scholarship from
CLHSAA?__________ Year:______________
(NOTE: If you are fortunate to receive a full
scholarship from another source, please decline our scholarship and
notify us ASAP so that we may help as many other students as possible.)