LEAF Student Scholarship Application 1. Name(Required) First Last 2. Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) 3. Please select the township in which the student resides:(Required) Lehighton Borough Franklin Mahoning East Penn Weissport 4. Class Ranking(Required) 5. Place of Employment(Required) Present Year in School/College(Required) 6. Lehighton Elementary School(s) attended:(Required) Number of years attended:(Required) 7. Student’s Income from Last Tax Year: $(Required) 8. Have you saved any money toward your education?(Required) Yes No 9. Current total cash balance of student’s checking and/or savings accounts: $(Required) 10. How was this money obtained?(Required) 11. College/trade schools where you are accepted:(Required)12. College/trade school where you plan on attended:(Required) Your major or intended field of study there:(Required) 13. Campus status:(Required) Off-campus housing With parents With relatives Commuter 14. Total expenses for student for academic year: Tuition and fees $(Required) Room and board: $(Required) 15. How much annual financial help can your parents provide? $(Required) 16. Would you accept work study and/or loans as part of your financial aid package?(Required) Yes No 17. Have you applied for: A. Other local scholarships(Required) Yes No B. Federal and State Aid(Required) Yes No 18. List the total amount of scholarship money awarded to date: $(Required) 19. Name of person(s) you live with:(Required) 20. Father or guardian’s employer:(Required) Job title:(Required) 21. Mother or guardian’s employer:(Required) Job title:(Required) 22. Please select the range for total gross family income for the household which you live:(Required) less than $10,000 $10,000-$19,999 $20,000-$29,999 $30,000-$39,999 $40,000-$49,999 $50,000-$74,999 $75,000-$100,999 $101,000+ 23. The number of applicant’s brothers and sisters who will be dependent on applicant’s parents for college next year:(Required) 24. Number of tax dependent children (including applicant):(Required) 25. Did you or your parent/guardian(s) attend any of the financial aid sessions held here at the high school?(Required) Yes No Did you find it helpful? Yes No Did you or your parent(s) attend any of the financial aid sessions held in any of the local colleges?(Required) Yes No Did you find it helpful? Yes No 26. Please explain any unusual circumstances concerning your family’s financial situation:(Required)27. Please list school-based extracurricular activities, including any leadership positions, awards and years of involvement:(Required)28. Please list community-based activities and volunteer services, including any booster clubs. Also, list any leadership positions and employment:(Required)I have reviewed this application and approve all the statements made:(Required) Yes Parent/Guardian's Name (signifying consent)(Required) Applicant's Name (signifying consent)(Required) Applicant's Social Security Number(Required) Failure to complete the application IN FULL OR MISREPRESENTING PERSONAL INFORMATION WILL DISQUALIFY THE APPLICANT FROM CONSIDERATION. All applications must be submitted by Friday, February 25, 2023 at 3 p.m.CAPTCHACommentsThis field is for validation purposes and should be left unchanged. 64926
