The Dr. Carlos E. Castañeda Memorial Scholarship Application

LPI does not discriminate on the basis of race, color, national origin, disability, age, gender, or religion according to the EEOC guidelines.

LPI is no longer accepting scholarship applications for the 2012 summer.

Student Information

Salutation *

Student's First Name *

Student's Last Name *

Permanent Street Address *

City *

State *

Zip Code *

Phone *

Email Address *

Date of Birth *

Program Information

Location *

Session *

High School Information

High School Name *

High School City *

High School State *

Current Status *

Cumulative G.P.A. *

My U.S. high school is a: *

Do you receive financial aid at your high school? *

High School Language Courses (please include course title and grade) *

Employment

I currently hold a part-time job: *

I work during the summer months: *

If you answered YES to either of the above questions, please list your employers, their contact information and your job titles below.

Extracurricular Activities

Please indicate any extracurricular activities that you currently participate in and any leadership positions you hold.
(Example: varsity basketball, captain / drama club, treasurer)

Family Information

Relationship *

Parent's / Legal Guardian's Name *

Parent / Legal Guardian Occupation *

Relationship

Parent's / Legal Guardian's Name

Parent / Legal Guardian Occupation

How many siblings under 21 years of age do you have? *

Please describe any special financial circumstances with your family. These may include: additional family expenses, loss of job, or family illness or death.

By clicking on "Submit," I affirm that all information supplied is true and correct to the best of my knowledge.

The Dr. Carlos E. Castañeda Memorial Scholarship Application

LPI is no longer accepting scholarship applications for the 2012 summer.

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