LANHAM FOUNDATION YOUTH SCHOLARSHIP

PURPOSEINITIAL APPLICATION

The purpose of the Foundation is to provide higher education scholarships to students age 17 to 22 who are residents of Chelan County, citizens of the United States, and in need of financial assistance. Institutions which may be attended include: junior colleges, technical schools, universities and similar institutions for graduates of Chelan County high schools and students at Wenatchee Valley College.

SELECTION CRITERIA

Scholarships will be awarded based upon the following criteria:

•Results of formal tests.•Financial need.•Academic performance.•Recommendations: Note: Recommendations should address ability, industry, character, and promise of useful citizenship.

PERSONAL INFORMATION

Name: Ms. Mr.

Permanent Mailing address:BOX NO./STREET CITY

_STATE ZIP

Telephone Area Code/Number

Social Security Number _

High School: Graduation date: _Cumulative GPA: Rank in class:

--------------

Parents:Father Occupation _ Mother Occupation _ Brothers (give ages) _

Sisters (give ages) _

Others

---------------------------------------DO YOU HAVE A SIBLING APPLYING FOR OR CURRENTLY RECEIVING A LANHAM

I have attached the following required documents to my application. Applications that do not have these attachments will automatically be disqualified:

Official high school/college transcript (must have official seal or signature - a copy will not be accepted)

First 2 pages of parents' 2016 income tax return if parents are filing joint income tax return. If parents are not filing a joint income tax return, first 2 pages of both parents' 2016 income tax return (previous year's returns will not beaccepted - do not attach to application) (student's income tax return if independent status claimed)

Letter of recommendation from high school administrator or counselor

Letter of recommendation from one other person

Copy of SAT or ACT scores (if attending a 4

FOUNDATION SCHOLARSHIP? ---------------

Length of residency in Chelan County: yearsCitizen of United States Yes No Birth date ----------

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PERSONAL INFORMATION (Continued)

Honors and awards (year and nature of honor or award)Scholastic---------------------------------

Extracurricular (school related) _

Civic (non-school related) _

Office and positions (name of organization, position and year)Scholastic---------------------------------

Extracurricular (school related) _

Civic (non-school related)---------------------------

Participation in school, extra-curricular and civic activities (where no office was held) indicating organization and year (list only major activities)

Scholastic---------------------------------

Extracurricular (school related) _

Civic (non-school related) _

College or university you plan to attend: Major: Is this a 4-year or 2-year college or university? Address:

What are your career goals? _

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FAMILY FINANCIAL INFORMATION

DIRECTIONS:If the parents of the student are filing a joint income tax return, the parents must attach to this application a copy of the first two pages of their income tax return for the preceding year (201 6) . If the parents of the student are not filing a joint income tax return, each parent of the student must attach to this application a copy of the first two pages of their income tax return for the preceding year (2016). Before a claim of independent status will be considered, a student is required to attach a copy of their own income tax return for the preceding year (2016) and a copy of the first two pages of their parents' income tax return for the preceding year (2016).

ASSETS LIABILITIES

Cash on hand and in banks Notes Payable explain:

Real Estate (value of home & poverty)

Household goods

Automobiles and trucks Real estate mortgage and contracts

Contracts and mortgages receivable Installment obligations, explain:

Stocks and bonds

Savings certificates

Cash surrender value of life insurance Amount borrowed on life insurance

Child support (yearly) Child support (yearly)

Other assets, describe: Other liabilities, describe:

TOTAL ASSETS TOTAL LIABILITIES

NET WORTH

INCOME FOR YEARSalary or wages

Partnership draws

Commissions and bonuses

Dividends and interest

Rentals

Child Support

Maintenance (Alimony)

Adjusted Gross Income (from tax return)

Use the space below to elaborate on any aspect of your family's financial situation that you feel the Committee should know:

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FILING INFORMATION

This application must be received by April 1. Send to: MR. JAY A. JOHNSON, Davis Arneil Law Firm, 617 Washington Street, Wenatchee, WA 98801.

No applications will be considered unless it includes the following:

1 . Personal information.2. Family or independent student status financial information INCLUDING 2016 INCOME TAX RETURN(S) . 3. Two letters of recommendation, one of which must be from a school administrator (superintendent, principal, assistant principal, or counselor). Students currently in college must attach one letter of reference from a college professor or administrator and one letter from their high school counselor or administrator.4. Official high school transcript indicating cumulative GPA and official college transcript if applicable.5. Copy of either the SAT or ACT (except if you plan to attend a two-year college or vocational school).

AGREEMENT OF CONDITIONSEach applicant for a Lanham Scholarship agrees to accept and comply with the following conditions:1. Scholarships will be awarded only to students who agree to attend full time and graduate with a specific degree

from a designated educational institution. Such institution must be one which maintains a regular faculty and curriculum and has a regularly organized body of students in attendance at the place where its educational activities are carried on. The student shall enroll in not less than the minimum number of credit hours re q uired for full-time student status by the educational institution and make normal progress toward graduation. The student shall maintain a 2.5 cumulative grade point average. With the consent of the Committee, a student may transfer to other educational institutions so long as such institutions meet the qualifications described above.

2. Each student receiving a scholarship shall render the following written reports to Jay A. Johnson, 617 Washington Street, Wenatchee WA 98801 not later than 30 days following the conclusion of each school semester or quarter: A. Each course taken and the grades received (a copy of your transcript), including the credits obtained if a credit

system is in effect, verified by the educational institution.B. Each student whose study at an educational institution does not involve the taking of courses but only the

preparation of research papers or projects must submit an annual report on the progress of the paper or project; which report shall be approved by the faculty member supervising the student or by another appropriate university official. In addition, the student shall submit a final report upon completion of his or her academic program at the educational institution.

C. An account summary/financial aid printout from your college showing scholarship funds and financial aid expended during the term, and an itemization showing how the Lanham Scholarship was used (tuition, books and supplies, including board and room if applicable).

3. Students must provide written notification if they attend a different school than is stated on the application. Said written notice shall be sent to: Jay A. Johnson, 617 Washington Street, Wenatchee WA 98801 and Lanham Scholarship Trust (Account No. 73-11-111-8451320), % Trust Department, Bank of America Private Center, TXl-609-08-05, PO Box 830259, Dallas, TX 75283-0259.

No scholarship shall be continued unless the foregoing conditions have been complied with to the satisfaction of the Trustee. The Lanham Foundation reserves the right to rescind or modify a scholarship award if a student changes schools after a scholarship has been awarded but before the student has completed the school year. The Lanham Foundation also reserves the right to rescind or modify a scholarship award if a student has or will receive other financial aid (grants, scholarships, awards) the total sum of which will exceed the calculated annual cost of attending the college/university the student is attending.The undersigned applicant for a Lanham Foundation Scholarship Grant and the undersigned parent or guardian hereby certify that all of the financial information contained in this application is true and accurate. The undersigned applicant further states and certifies he or she accepts and agrees to observe the above terms and conditions. The undersigned applicant further certifies he or she understands the scholarship grant, if awarded to the undersigned, will be subject to termination if the aforementioned terms and conditions are not observed by the undersigned.

Finally, the undersigned certify they understand that this is a one-year scholarship which must he annually reapplied for by April 1.

Applicant's signature Date Parent/Guardian's signature Date

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