C. Valentine Bates Memorial Hope Scholarship

Applicant Information

Please provide First Name.
Please provide Address
Please provide Middle Name.
Please provide City
Please provide Last Name.
Please provide Zip
Please provide Date of Birth
Please provide Age
Please provide a valid student email address.
Please provide a valid parent/guardian email address.
Please provide a valid counselor email address.

High Schools Attended: (9th through 12th grades)

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Elk/Lodge Information

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Please provide Elks Name
Please select Lodge
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Work Experience/Employment History

List jobs held starting with the most recent and include work on a family farm or for a family business even if you were not paid.

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Leadership and Extracurricular Activities

List your principal leadership roles and extracurricular activities in order of importance to you. Examples include but are not limited to student government, publications, debate, orchestra/band, varsity athletics, church groups, performing arts, and service programs.

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Honors and Awards

Include all scholastic, extracurricular, and civic honors and awards earned during high school and describe each. Please include only significant honors and awards.

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Community Service

List volunteer work or community service you performed without pay during the last 4 years.

Please provide Kind of Work
Please provide Kind of Work
Please provide Kind of Work
Please provide Kind of Work
Please provide Employer Phone
Please provide Employer Phone
Please provide Employer Phone
Please provide Employer Phone
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College Plans

Please rank the order of the factors most likely to influence your college enrollment decision using number 1 through 8. (1=most, 8=least)

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Please provide Employer Name
Please provide Employer Phone
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Other Financial Aid

Please

Applicant Essay

Topic: “Why you deserve a scholarship and what your future aspirations are.”
Applicants are required to write an essay of 250-300 words.

The essay must include answers to the following:

  1. The area of study where the scholarship would be applied
  2. Why this area was selected
  3. How your education will benefit society
  4. What college or school you are currently considering
Please type your personal essay or upload an essay document.
Please select a supported file. Allowed: PDF, DOC, DOCX, TXT, RTF. Maximum 25 MB (25 MiB) per file; 60 MB (60 MiB) total and up to 20 files across all upload fields.

Exhibits of Achievement

Your application package may contain up to three (3) pages of copies or exhibits depicting achievement in scholarship, leadership, athletics, dramatics, community service, or other activities.

Please select a supported file. Allowed: PDF, DOC, DOCX, JPG, JPEG, PNG. Maximum 25 MB (25 MiB) per file; 60 MB (60 MiB) total and up to 20 files across all upload fields.

Additional Non-Sensitive Documents 

Upload non-sensitive documents below. Tax returns, financial information, etc., should be uploaded via secure link provided after application submission via email.

Please select a supported file. Allowed: PDF, DOC, DOCX, JPG, JPEG, PNG. Maximum 25 MB (25 MiB) per file; 60 MB (60 MiB) total and up to 20 files across all upload fields.

Parental Financial Information

In addition to the most current tax return, a statement of 200 word or less may be included summarizing the family’s obligations, resources, and any other extenuating circumstances.

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Custodial Father's Marital Status:
Custodial Father's Marital Status:
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Custodial Mother's Marital Status:
Custodial Mother's Marital Status:
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With whom does student make his/her permanent home?
With whom does student make his/her permanent home?
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Dependents

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Signature

Please enter Date
Signature Required