Lloyd Balfour Application

Instructions

Complete all of the required fields. Upon successful completion, submit your electronic application by hitting the Submit button at the bottom of this page. You will then be presented a finished version for you to print and mail in with the Additional Materials that are required to complete this application.

* = Required fields

Application Form

Applicant's Information

First Name *
Middle Name: (optional)
Last Name *
Citizenship *
Intended Career *

E-mail Addresses

E-mail Primary *
E-mail Secondary: (optional)

Phone Numbers

Phone Primary (xxx) xxx-xxxx*
Phone Secondary: (optional)

Current Address

Address Line 1 *
Address Line 2: (optional)
City *
State/Provience *: (required for US/Canada)
Region: (outside US/Canada)
Zip/Postal Code: (required for US/Canada)
Country *

Permanent Address (if different from above)

Address Line 1
Address Line 2: (optional)
City
State/Provience: (required for US/Canada)
Region: (outside US/Canada)
Zip/Postal Code: (required for US/Canada)
Country

Fraternity Affiliation

Fraternity *
Chapter *
Year Initiated *
Fraternal and Interfraternal Service (activities and offices held)*

Undergraduate Institution #1

School/University *
School State *
Start Date *: (month) (year)
End Date (graduation, transfer, or expected date of graduation)*: (month) (year)
Degree Earned *
Cumulative GPA *
Major(s) *
Minor(s)
Campus and Community Service (Activities and offices held)
Extracurricular Activities (Honors, Awards, Honor Societies)

Undergraduate Institution #2 (if applicable)

School/University
School State
Start Date: (month) (year)
End Date (graduation, transfer, or expected date of graduation)*: (month) (year)
Degree Earned
Cumulative GPA
Major(s)
Minor(s)
Campus and Community Service (Activities and offices held)
Extracurricular Activities (Honors, Awards, Honor Societies)

Graduate Institution #1

School/University *
School State *
Start Date *: (month) (year)
End Date (graduation, transfer, or expected date of graduation)*: (month) (year)
Degree Earned *
Cumulative GPA *
Major(s) *
Minor(s)
Campus and Community Service (Activities and offices held)
Extracurricular Activities (Honors, Awards, Honor Societies)

Graduate Institution #2 (if applicable)

School/University
School State
Start Date: (month) (year)
End Date (graduation, transfer, or expected date of graduation)*: (month) (year)
Degree Earned
Cumulative GPA
Major(s)
Minor(s)
Campus and Community Service (Activities and offices held)
Extracurricular Activities (Honors, Awards, Honor Societies)

Employment #1 (if applicable)

Company Name
Company City
Company State
Job Title
Start Date: (month) (year)
End Date: (month) (year)

Employment #2 (if applicable)

Company Name
Company City
Company State
Job Title
Start Date: (month) (year)
End Date: (month) (year)

Essay

Describe your contributions to the enhancement of fraternal ideals and discuss their application to your future career *: (less than 500 words)

Additional Materials

We have revised our procedures and will only require a letter of admission to a graduate school and a copy of your undergraduate transcript if you are among those selected to receive the scholarship. You will be notified if you have provisionally been awarded a scholarship. There is nothing further that you need do at this time.

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About

Lloyd Balfour Application

Instructions

Application Form