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Gem lake Scholarship.Award Application Form Rev. 09 28 2011 <br />City of Gem Lake <br />Scholarship Award Application. <br />4200 Utter Lake, Road s- ` <br />teem Lake, MN 5$110-3763 <br />Phone 6514474790 <br />Applicant Narrie: O+Y1t`C �_M'% W Caro ��n <br />last First 0 Middle V. <br />Home Address; Shf,uoty CYi 61a(" iOYiQ_ t6N <br />street City State Zip Code <br />Date of Birth:. High.s`choob\4 iit.,�&Gt�atf, Year of Graduations._.,_ <br />High School Address: tAC VIN0)D ' NV4- BSI iO Phone Nurriber:(o'SI <br />Street City Zip Code <br />Parent(sy.Name(s),A Y�,lU �CAYL[�CZSIlGi` , `DA iLI rir_r <br />Home Address: Waal ,fi`4MCLY1 C7- t—m- U,%%Q tAN _ It's ICQ„ . <br />Street City State . Zip Code <br />Part I- To be completed by Applicant: <br />.. r.aa t• A I. r. <br />��_' ► 1 r ail.' � I. a► i/�/ i . �� <br />What college or technical school do you plan to attend? l7 <br />What field of study are you.planning to enter?_� <br />1 <br />Are you. employed?�_ Employer? (hex �(il,V 1- �`4_ ' �1,V�S. <br />6611 <br />Positionri(M �IkMi r �;p� _� _ Hours per week: 140 <br />YYiaY�e, �c�, �cw�5 <br />