Form

2012 Golf Privilege Card Scholarship Application

A committee of American Lung Association staff and volunteers will make the final decision of award recipients after reviewing all applications.
Full Name*
First Name Last Name
E-mail*
Phone Number*
- Area Code Phone Number

Mailing Address*

Birth Date*
Month Day Year
High School*
Date of Graduation*
Number in Graduating Class*
Rank in Graduating Class*
Name and address of the college/university you are enrolled in for the 2012 - 2013 academic year*
Academic Program Persuing
Essay: Describe how lessons learned through your involvement in the game of golf will influence your future. (minimum 300 words)*
Please submit the following, to be included with your application, by March 16, 2012.*

- Letter of reccomendation from a person with first hand knowledge of your academic ability and achievement.

- Letter of reccomendation from a person with first hand knowledge of your involvement with the game of golf (ie: golf coach, golf professional or course manager).

- Proof of acceptance to post-secondary education institute for 2012/2013 academic year.

Materials can be sent to:
American Lung Association
Attn: Kristen Soule
122 State St.
Augusta, ME 04330

With questions or to request further information, please contact Kristen at ksoule@lungne.org or at
888-241-6566 ext. 0306

*All requested information must be provided. The American Lung Association in Maine assumes no responsibility for incomplete or late applications. Incomplete applications will not be considered for selection. Required application materials will not be returned.
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2012 Golf Privilege Card Scholarship Application