THE LILY FOUNDATION OF AMERICA INC.

P. O. Box 59824, Dallas, TX 75229 V 11

Application for SMILE © Scholarship

[DO NOT LEAVE ANY FIELD BLANK]

Student Info:

1. Name: _________________________________________2. Sex: M/F 3. Birthdate __/__/__

yr mo day

4. Class (or Grade): _____ 5. In school-year: 200_ - 200_

6. Total number of students in Class: _____ 7. Your rank in Class: _______

8. Majoring in Science/ Humanities/ Commerce/ Other:

9. Do you receive any scholarship/ stipend now? 10. If yes, what and how much?

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School Info:

10. High School name:

11. Address (include PIN code): 12. Email address:

13. Principal/ Headmaster’s name: ______________________________

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Family Info:

13. Father’s name: ___________________________________ Occupation:

14. Mother’s name: ___________________________________ Occupation:

15. Home Address (include PIN code):

16. Total Monthly Family Income (Add income from both parents and other resources):

17. How many persons in the household?

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18. References (Name two respectable persons with addresses and phone numbers who know you)

Ref 1._________________________________________ email:

Ref 2._________________________________________ email:

19. How do you want to use the money (Enter amounts assuming you get RS. 500/- a month)?

Private Tutor ____________ Books & Stationery __________ Transportation___________

School uniform ___________ Any Other ________________

20. How do you prefer to receive the money (select one)?

___ Cheque (if you prefer a payee other than yourself, mention name and address)

___ Bank Transfer (Provide A/C No.) ___ Cash (every 3 mos. in person)

Approval /Comments/Date:

_____________________________ __________________________

President, Lily Foundation Applicant’s signature Date __/__/__

______________________________________________________________________________________

NOTE to the Applicant: Please read thoroughly the Rules & Requirements below before filling. Incomplete applications will be discarded without consideration.

THE LILY FOUNDATION OF AMERICA INC.

Rules

i) The Board of Directors decision is final on candidate selection.

ii) The scholarship is normally awarded for the current full academic year, which is likely to be continued through the end of the High School grades (10^th Gr. or 12^th Gr.). However, it needs to be endorsed by the foundation every year.

iii) The foundation retains the authority to cancel the scholarship any time during the year if there is a good reason for it.

iv) The scholarship is a non-refundable grant that will be spent toward the student’s tuition, books, transportation and other education-related costs.

Requirements

A. The student will completely fill the application (except for the approval) by his own hand-writing. DO NOT LEAVE ANY ITEM BLANK.

B. The application for the scholarship will accompany the following:

1. One recent photograph of the student

2. If possible, one photograph of the family in front of the house

3. A photocopy of the student’s last report card from the school

4. On a separate sheet, write the student’s involvement in school, home and community activities. Examples of these activities are: Sports team member or captain, Organize clubs /associations; Participate in dramas or play musical instruments; Help family by earning money etc.

5. Headmaster’s recommendation (If not available, state the reason on the separate sheet (item 4 above), and send a recommendation from one of your teachers as well as a recommendation from a respectable person who knows your family personally.)

C. After every year’s final exam, send a photocopy of the report card attested by your teacher (if original not available) to the foundation’s India office (or US office). Good grades are expected.

D. Any change of address or dropping out of school for any reason should be immediately reported to the foundation.

Note: Your provided data may be utilized by the foundation for fundraising

Explanation of Items overleaf

Item 7: If exact rank is not available, then provide estimate, such as 32 out 80.

Item 11, 15, 18: Provide full address including P.O. name, District, State and PIN code. Provide email address whenever possible,

Item 20: Since it is possible that the student does not have a bank account, you may provide an alternative payee name and address where the cheque should be mailed to.

012204

Foundation Officials Notes:

DO NOT consider any application that is not filled properly and completely
DO NOT consider any application that has missing requirements (A thru’ D)
Select a Mentor. One of the two references may be chosen if others are not available.
Disposition applications with comments – particularly those not approved
Emphasize on Headmaster’s comments – Academic strength, Economic background and Extra-curricular activities
Administrator, precisely determine the school-year, class and % of total score in the submitted mark-sheet. Next year’s review will compare against this score.

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