LEAF Student Scholarship Application 1. Name(Required) First Last 2. Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 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.CommentsThis field is for validation purposes and should be left unchanged. 93436
