Mary Hall Mantooth Chapter Daughters of the Republic of Texas

GENERAL SCHOLARSHIP APPLICATION FORM Seniors 2020

RETURN TO

Susan Sumners, 107 Winged Foot, Lufkin, TX 75901 susan@sumners.com

Part I: Student General Information

List only members in your household. If divorced list custodial parent.

Father/Step Father/ Guardian: Employer

Mother/Step Mother/Guardian: Employer

Part II: Short resume of activities and plans for education. Write a short essay outlining your activities and interests. Include a section explaining your plans for

college, technical school or military, your choice of majors and what you hope to achieve for your

future career.

Part III: Genealogy Chart- Using primary sources (such as birth certificates, death certificates,

marriage certificates, Census records, Wills, Land records, tombstones, newspaper obituaries) trace

your ancestors back to the Republic of Texas Era. Members of the Children of the Republic of

Texas need only attach their membership #___________.

Part IV: Student/Parent Agreement: Read and Initial

I agree to send a thank you note to my scholarship donor(s).

Applicant’s Signature: Date:

Parent/Guardian Signature if not 18: Date:

High School Attending: How Long:

Checklist for completion: ___ I have completed Part 1 with General information. ___ I have completed Part 2 essay indicating activities college attending, major, and plans. ___ I have attached the genealogy chart or Membership number in Children of the Republic of Texas ___ Place application into ONE Brown 9x11 envelope with last name, first name, and ID#.

Last Name: First Name:

Address: Phone #:

City: State: Zip Code:

Date of Birth: Age: email:

Attach a recent head and

shoulders photograph.

This is for identification

purposes to help put a face

with a name. Professional

photographers are not

necessary. Photocopies of

the photographs are

acceptable. Have your counselor complete this section using your school’s grading and ranking system. GPA on 100 ________ Rank:_______ of _______ Date of rank:______________ ACT Composite:_________ SAT:_______ (cr & math only) _______________________________ Date signed:_______________________ Counselor Signature