Lebanese American Heritage Club

*Date:
Example: 00/00/0000

*Social Security No:
Example: 000-00-0000

*Name:

*Address:

*City:

*State:

*Zip code:

*Phone:
Example: 000-000-0000

*Email:

*Date of Birth:
Example: 00/00/0000

*Place of Birth:

*Marital Status:

Single Married

If married, number of children:

*What is your legal status?

U.S. Citizen Permanent Resident

A #:

*Proof of Arab descent (i.e., father, mother, etc.):

*Country of Origin (i.e., Lebanon, Iraq, Yemen, etc.):

*Name of High School / College / University you are currently attending:

*Name of College / University you will attend next year:

* Class Status (i.e., Freshman, Sophomore, Junior, Senior, Graduate Student):

* Proposed Field of Study (be specific):

* Are you receiving any other scholarships or financial aid this year?:

No Yes

If yes, please explain in detail:

*FAFSA “EFC” score appearing on SAR:

*Please list all extracurricular activities (school related):

*Have you ever received the LAHC Scholarship?

No Yes

If yes, when?

*Please type LAHC (all upper case)
*
This confirms the legitimacy of your application and eliminates spam.