Name of Applicant for scholarship:

Last 4 digits of your SSN: Major: Address: City: State: ZIP:

Home Phone: Name of Scholarship Requested:

College Hours Earned: LSUS Overall   LSUS GPA Overall GPA

Briefly describe your participations, memberships, and activities at LSUS:

All infomration provided on this application is confidential. Please make every effort to justify your receiving one of these scholarships.