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Gem Lake -Scholarship Award Application Form <br />Rev. 09 23 e 01", <br />City of Cem Lake <br />_ Scholarship Award Application ` <br />^' `r 4260 Otter Lake Road <br />Gem Lake, MN 551I0-3753 <br />Phone 654-747-2790 <br />Applicant Name: <br />Last i irsl Middla <br />Home Address: i r :., L' ,,, e.. Ut - I.AIAJ '5'n a 0 <br />Street City Smite Zip -Code <br />€]ate of Birth: 4Z1cti1 High School: �iJ .t hL �i +�< 5,� ^` ear of*draduation. �• i <br />High School Address: i t -r: wt �;,:�a w�tc cct,.� 'o7u,�Phone Number: ti —713 t' to <br />Street City. Zip.Code <br />Parent(s) Name(s):_._ t;�Tc�,'t <br />Home Address: lk, 4 .(rzrq <br />Street City State Zip code <br />Part I- To be completed by Applicant: <br />What. is:you.r educational objective? P%­i 1 u J, > ut +: �Z::�=''`L tI <br />CA\k1t VY% �, %A``Pt f" <br />5 ►`. it � •;; lnc i t �.,,r ',�.� �-e�c\o4c i^tt t hc�.nrr� L�..:+ 'w �' ` � , <br />What college or technical school do you plan to attend?� <br />What field of study are you planning to enter? <br />Are you employed? � z' Employer? <br />Position; _ Hours .per. week: <br />