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Applicant Name: <br />Last <br />Home Address: <br />Gem Lake Scholarship Award <br />First <br />Street City <br />Date of Birth: High School: <br />High School Address: <br />Street <br />Parent(s) Name(s): <br />Home Address: <br />City Zip Code <br />State <br />Middle <br />Zip Code <br />Year of Graduation: <br />Phone Number: <br />Street City State Zip Code <br />Please Answer Carefully <br />Part I- To be completed by Applicant: <br />What is your educational objective? <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? <br />Position: <br />WE <br />Employer? <br />Hours per week: <br />