(L.S.S.K.)

LYNN SAWCHUK-SHARON KUZBYT SCHOLARSHIP APPLICATION FORM

Applicant Form

(The Applicant is to complete this form and forward to the L.S.S.K. Scholarship Committee Chair along with their transcripts and all other recommendation forms in the proscribed manner.)

APPLICANT’S NAME ________________________________________________________________________

ADDRESS ________________________________________________________________________

________________________________________________________________________

U.O.L. CHAPTER ________________________________________________________________________

REFERENCE FORM TO BE COMPLETED BY JR. CHAPTER PRESIDENT OR VICE PRESIDENT

JR. CHAPTER and CHURCH ACTIVITIES

MEMBER U.O.L. CHAPTER: # YRS._____

OFFICER: Yes _____ No _____ OFFICES________________________________________________

COMMENTS

CHURCH CHOIR Yes _____ No _____ ____________________________________________

DANCE GROUP Yes _____ No _____ _____________________________________________

CHURCH READER Yes _____ No _____ _____________________________________________

ALTAR SERVER Yes _____ No _____ _____________________________________________

DANCE INSTR. Yes _____ No _____ _____________________________________________

CATERING SVC. Yes _____ No _____ _____________________________________________

_______________ Yes _____ No _____ _____________________________________________

CHURCH COMM’S. Yes _____ No _____ _____________________________________________

ADDITIONAL COMMENTS: __________________________________________________________________________________________

____________________________________________________________________________________________

HIGH SCHOOL ACADEMIC TRANSCRIPT: AN OFFICIAL COPY OF THE APPLICANT’S HIGH SCHOOL ACADEMIC TRANSCRIPT MUST BE FORWARDED ALONG WITH THE APPLICATION FORMS AND RECOMMENDATION LETTERS TO THE SCHOLARSHIP CHAIR AS DIRECTED IN THE ENCLOSED INSTRUCTIONS.

SIGNATURES: Jr. UOL Chapter President/Vice President __________________________________________

Jr. UOL Chapter Advisor __________________________________________

Spiritual Advisor __________________________________________

[NOTE: Statements of performance must not be prepared by the applicant or a family member.]

Completed Applications are to be sent to: Daria A. Pishko, 64 Coleman Avenue, Chatham, NJ 07928 (973) 635-8124.

DEADLINE: MAY 31st

(Reference Questionnaire)

(L.S.S.K.)

LYNN SAWCHUK-SHARON KUZBYT SCHOLARSHIP APPLICANT FORM

Spiritual Advisor Form

(The Spiritual Advisor is to complete this form and return it to the Applicant in a sealed envelope for submittal to the L.S.S.K. Scholarship Committee Chair.)

APPLICANT’S NAME ______________________________________________________________

U.O.L. CHAPTER _______________________________________________________________

JR. CHAPTER/CHURCH ACTIVITIES:

UOL Member Yes _____ No _____ Years ______

Officer Yes _____ No _____

Dance Group Yes _____ No _____

Church Reader Yes _____ No _____

Altar Server Yes _____ No _____

Dance Instr. Yes _____ No _____

Reg Attendance Yes _____ No _____

at Liturgies

Reg. Participation Yes _____ No _____

in Sacraments

Volunteers Yes _____ No _____

________________ Yes _____ No _____

COMMENTS:

__________________________________________________________________________________

______________________________ _____________________________ _______________

SPIRITUAL ADVISOR (Signature) (Print Name) (Date)

Questions regarding applications may be directed to:

Daria A. Pishko, 64 Coleman Avenue, Chatham, NJ 07928 (973) 635-8124.

DEADLINE: MAY 31st

(Reference Questionnaire)

(L.S.S.K.)

LYNN SAWCHUK-SHARON KUZBYT SCHOLARSHIP APPLICANT FORM

Jr. Chapter Advisor Form

(The Jr. Chapter Advisor should complete a copy of this form and return it to the Applicant in a sealed envelope for submittal to the L.S.S.K. Scholarship Committee Chair.)

APPLICANT’S NAME _______________________________________________________________

U.O.L. CHAPTER _______________________________________________________________

JR. CHAPTER/CHURCH ACTIVITIES:

UOL Member Yes _____ No _____ Years ______

Officer Yes _____ No _____

Dance Group Yes _____ No _____

Church Reader Yes _____ No _____

Altar Server Yes _____ No _____

Dance Instr. Yes _____ No _____

________________ Yes _____ No _____

COMMENTS:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________ _____________________________ _______________

JR. CHAPTER ADVISOR (Signature) (Print Name) (Date)

Questions regarding applications may be directed to:

Daria A. Pishko, 64 Coleman Avenue, Chatham, NJ 07928 (973) 635-8124.

DEADLINE: MAY 31^st

(Reference Questionnaire)

(L.S.S.K.)

LYNN SAWCHUK-SHARON KUZBYT SCHOLARSHIP APPLICANT FORM

Scholastic Advisor Form

(A high school principal, guidance counselor or teacher should complete a copy of this form and return it to the Applicant in a sealed envelope for submittal to the L.S.S.K. Scholarship Chair.)

Please note an official copy of the student’s transcripts must also be submitted.

APPLICANT’S NAME _______________________________________________________________

U.O.L. CHAPTER _______________________________________________________________

HIGH SCHOOL EXTRACURRICULAR/CIVIC (COMMUNITY) ACTIVITIES:

Student Council Yes _____ No _____

Office(s) ___________________________________________________________________

Theater Yes _____ No _____

Band - March Yes _____ No _____

Band - Symphony Yes _____ No _____

Athletics Yes _____ No _____

Intramurals Yes _____ No _____

Honors/Awards________________________________________________________________________________________________________________________________________________________

Clubs/Organizations _________________________________________________________________

__________________________________________________________________________________

______________________________ _____________________________ _______________

High School Representative (Signature) (Print Name) (Date)

Questions regarding applications may be directed to:

Daria A. Pishko, 64 Coleman Avenue, Chatham, NJ 07928 (973) 635-8124.

DEADLINE: MAY 31st

Application/Administrative Requirements

All LSSK scholarship applications must be submitted via CERTIFIED MAIL with RETURN RECEIPT REQUESTED, or another comparable means (e.g., FedEx, UPS, etc.) that provides a return receipt or tracking number/process.

1. Each Recommendation Form must be submitted in separate envelopes.

2. These envelopes should be sealed by the Recommender and signed by the Recommender ACROSS THE SEAL OF THE ENVELOPE.

3. The Recommender’s sealed envelope should be returned to the applicant to be submitted with his/her application and official transcript.

4. All materials for the scholarship should be sent by the applicant as one packet to the LSSK Chairman VIA CERTIFIED MAIL, or another carriers as indicated above.

A Postal Card indicating receipt of the application will be sent to each applicant and will notify said applicant of any incomplete information.

1. If the application arrives on or before the deadline date and is complete, the postal card will indicate that the application is complete and will be considered for a scholarship.

2. If the application arrives on the deadline date and is not complete, the postal card will indicate that the application was incomplete and will not be considered for this year’s scholarship.

3. If the application arrives after the deadline date, the postal card will indicate that the

application did not meet the deadline and will not be considered for a scholarship.

Application Deadline: May 31, 2001