Lamar Gumbo Palooza Scholarship Application

Scholarship must be applied for through the Lamar Gumbo Palooza Scholarship process.

I, ________________________________________________, wish to be considered for the Lamar Gumbo

Palooza Scholarship Application (LPGSA). Permission is hereby given to officials of my institution to release transcripts of
my academic record and other requested information for consideration in the LPGSA program. I understand that this
application will be available only to qualified people who need to see it in the course of their duties.
This application, including my transcript, drivers license and letters of recommendations, are my own work or
formally cited from other sources. I affirm that the information contained herein is true and accurate to the best of my
knowledge and belief. All scholarship funds will be issued to the post-secondary institution. Therefore, invoice of course
registration fee and /or book fee are required. Additional documents such as a resume may be attached. Recipients are
eligible for continued scholarship support, but must reapply.

A. You, the Nominee

Legal Name:
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Last
First
M.I.
Permanent Residence:
Street and Number

City

County

State

Zip Code

Telephone number: ___________________________________ Email Address: _________________________________

Are you:

U.S. Citizen

U. S. National

U.S. Permanent Resident*

*(Permanent Residents must include a letter stating intent to become a U.S. Citizen and a copy of Permanent Registration Card)
(Permanent Residence is established by at least two of the following: home address for school registration; place of
voter registration; family primary residence.) All recipients or representatives are required to participate in fundraising
events. If you are selected as a recipient, you will receive notification by email or telephone.

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Printed Name

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Signature

____________________
Date

B. Your Aspirations
1. Describe career goal (Limit 600 characters with spaces).
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2. Describe overall educational plans to assist in achieving the career goal include any hardships that may have to be
overcome to reach those goals (limit 2000 characters with spaces).
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3. Describe Aransas Countys importance to you and what it means to be a part of this community. (limit 2000 characters
with spaces).
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C. Accolades
1. Cumulative GPA __________ on a __________________ scale

Class Rank ____________

2. List any awards, honors or scholarships received or possibly receiving.

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3.

Date

List any programs, activities, community service organizations or clubs in school or community. Please list in
order of significance.
Activity

Description

Hours spent per week

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4. List internships, assistantships or jobs (including summer employment) held in the past four years.
Dates

Employer

Description of Work

Hours worked

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