AMERICAN LEGION AUXILIARY
FORM E21G
Department of California
__2017_
Lucille Ganey Memorial Scholarship
This form intended for
Students attending Stephens College
When an application is submitted by a student for more than one scholarship offered by the Department or National, the student is eligible
to receive only one. A student may not receive more than one scholarship from Department in any one year.
Name of Applicant ________________________________________ You live: At Home
On your own
Address _________________________________________________ How long have you lived in CA? _________________
City, State, Zip ____________________________________________ Telephone __________________________________
Social Security # _________________________ Grade in school at time of application ______________________________
What course or vocation do you wish to pursue? ____________________________________________________________
Applicant must attend or be attending STEPHENS COLLEGE in Columbus, Missouri
Exact date you plan to enter school next semester ________________________________________________________
__________________________________________________________
Father/Guardian
Mother/Guardian
Name ____________________________________________
________________________________________________
Address __________________________________________
________________________________________________
Occupation _______________________________________
________________________________________________
Business Address __________________________________
________________________________________________
Information about brothers and sisters, if any. (Name, address, marital status, occupation) __________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Approximate NET (after tax) monthly income of family $_______________________________________________________
Source of income ______________________________________________________________________________________
Are you receiving aid from
:
Veterans’ Welfare Board?
Yes
No
Government Insurance Compensation?
Yes
No
S.R.A. (Servicemen’s Readjustment Allotment ?
Yes
No
State Educational Aid?
Yes
No
How Much
$______________________________
Does your family own a home
Yes
No
Are your parents able to aid you in any way at this time
Yes
No
If yes, to what extent? ____________________________________________________________________________________________
IF not, why?_____________________________________________________________________________________________________
E21G Page 1 of 2
For more information and application, go to Click on the word Scholarships