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r-_.._...__....---._._.._...-._._.._.................... _,-...._.._...._-_-._`._-..--..._'-'"-•---... .................... ...... _...-._-•"'--.........-._-..... ._..."'..- :._.._.._-._.... <br />City of.Gou Lake. Received <br />Heritage Hall <br />4200 Utter Lake Road I Cicm Lake, MN 551.14 Y 2 . 92 <br />651-747-279(JN2 165 t-74J-?795. (fax) <br />.{ E-mail cit.yCihPemlakcnin.or� <br />_.__.. City of Gem Lake <br />Scholarship Award Application <br />Req uiCgments; - <br />Ctuirnity lire ii alic.Cily �fCictei lake. <br />Gurrciilly a I{izh Schorr! SCni[N <br />i <br />Pica a IIt CIU tli': <br />�. Conil)leied AppIication <br />AI Ica.st two ['1) ldw s or refemncc irw .Schorrl Staff" <br />❑ Retuin to school alTciais by the third [3rd) Friday in Aprii 6rgradimdon year ; <br />❑ Mait ar bring a copy au tiac City of Gcm Luke, ]teritage Hail. byAril 30 of graduation ycur <br />Applicant -lnforatatinn�~���,��� <br />Name: _,I t 1'w m p'Cc1T � <br />Address: = Ccc,e- Ui1=t- )A. <br />City: G eini UIU-e Stale:. !-1 N Zip: ;;, I 1 D <br />Date vF9irtla; 4 ? ' 2:7 ? i:Clsj Grajuaria:i Year: 207_5 <br />Email. - <br />High Schiffol litformation <br />iIigh Seliook hihlikt: rlear._L4uNeo i-}igif SO-)oc,i 11igh School Phone: 651 ` 77'� <br />uty:. 1 S ] 1 V X­ 1''7.0 r Lt-i l-�e State: MINI Zip: 55.l f. . <br />Pure1100 IflfornuitiuIl <br />Parew Name; Art- Fieikyk 5 -- - -- Phonc: <br />Adrli'esti: . _ [7ws( - LcIV—t Pt <br />City: [:;em WJ Stale:..1 M Zip: G5110 i <br />i <br />Lliiail: <br />Parent Namc: phone.- <br />Adares5: u�` r Lt_,1�-k ILA. <br />City: zip-, 15.)I f D <br />L""mail; <br />Flpplietitit signatuic: 64 /0 <br />_..._............. ._....-_.._......... <br />City 6rGcm I,akc:Schahiship.AppiicitPork Pngc t W4 <br />