Name:

D. O. B:

Address:

City: State:  Zip:

Night Phone: , Cell Phone:

Name of affiliated member {M. W. Brighter Light member of Star light member} and relationship:

High School: 

Grade Point Average: Scale: (Example  GPA: 3.0 Scale: 4.0)

Expected Rank of Graduation:   out of:

Awards:

In a 1500 word or less doubled spaced, tell us why you be chosen as a recipient of this scholarship information: