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Gene Lake Scholarship Award Application Form Rev. 09 2$ 2011 <br />City. af' Gem Lake <br />Scholarship Awrard XpPlic:at'io>n. <br />.1.200-Otter I.akv Road <br />G.em La ke, NI N 55110-3 763 <br />11hane 651-747-279U.- <br />Applicant Name.: t ' �� ! .<r 00 <br />Las, first T...rA,.,.Jtr <br />tome Address' i i :.f) t ?t'�� 3�'� Lle, <br />Sheet +rdv State <br />Z p Ced. <br />�{ i s <br />Date of Birth: 1r' / 5/490 High School:y,/h f 6 61' �i';year of Graduation: <br />h .Schooi Address: _ t / !' ' b'z <br />Hi <br />g �f hone�NumSer. : i <br />Street oty�' Z:o Cock <br />Parent(s) Name(s): �. <br />iiome Address; r`jftj <br />5treCity Raw Zip Coda <br />Part]- 7o be completed by Applicant: <br />What is your educational objective? VVAO r }y l,..Cvr -W. 64 G tV <br />le <br />;.• �. }...� <br />7 1! Y' . , J.✓ t I �/ - ! f <br />i ;' <br />What coi.lege or technical scnoo€ do you plan: to attend.. /_ <br />What field of study are you planning to enter? 'i top j +'t'lEat'-' f+ <br />Are youemployed? grnolOyet?_ !��% WC2, _.�Citr ►r'•'t �/ �G t t„J� <br />Y ! <br />Pasi6on: a G roc) r ! Gel f''f C+," a .i hours per week: ( -� <br />FOR 2 8 2019 <br />