Online Scholarship Application Form

Please click here for details about our Scholarship Program.

Any questions about the application should be directed to your college counselor. Winners will be notified by telephone. The winners and their parents will be invited to the Mount Prospect Lions Club Festival at Melas Park on the 4th of July for presentation of the scholarships.

Application and all materials must be received by midnight June 1, 2024.

Note: this is a multi-step application which will need to be completed in one sitting. Please see the pdf form for necessary information and requested documents.

Step 1 of 4

I. Personal Information:

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Date of birth(Required)

Phone(Required)

Email(Required)

Enter Email Confirm Email

II. Family Data:

Father: Name

First Last

Father: Address

Street Address Address Line 2 City State ZIP Code

Father: Phone

Mother: Name

First Last

Mother: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mother: Phone

Guardian: Name

First Last

Guardian: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Guardian: Phone

IV. Activities & Honors:

School Activities & Honors(Required)

List school activities by year, including offices held, leadership positions, scholastic and other honors.

Attach a copy of your seven-semester report card(Required)

Accepted file types: pdf, doc, docx, jpg, gif, png, Max. file size: 32 MB.

V. Community Interest & Activities:

Community Interest & Activities(Required)

List volunteer work, service organization participation, church activities, etc.

VI. Personal Statement:

Essay(Required)

Write a short (one page maximum) essay describing a specific community service activity that you participated in, your role in the project and what you learned from the experience. If there are special circumstances or needs that you wish to advise the Committee of, you should mention them at the end of this statement.

Accepted file types: pdf, doc, docx, jpg, gif, png, Max. file size: 32 MB.

VII. References:

Letters of Reference(Required)

Attach three (3) LETTERS OF REFERENCE addressed to the Scholarship Committee. Include at least one instructor who has knowledge of your school performance. If you are, or have been employed, include one from an employer. The third can be from a coach, religious leader, community member or other individual with knowledge of your activities and achievements.

Drop files here or

Accepted file types: pdf, doc, docx, jpg, gif, png, Max. file size: 32 MB, Max. files: 3.

Date & Sign

Date of Application(Required)

Signature:(Required)

Please type your full name below to represent your agreement with this document submission.

Phone

This field is for validation purposes and should be left unchanged.

I. Personal Information:

II. Family Data:

III. High School Record:

IV. Activities & Honors:

V. Community Interest & Activities:

VI. Personal Statement:

VII. References:

Date & Sign