FLMI Society of South Central Texas

LOMA Society of South Central Texas

An organization that promotes insurance education and community service

Application for LOMA Scholarship

This form should be completed in its entirety. The only changes authorized to this form are changes to your entries. An incomplete application may disqualify you from further consideration.

The LOMA Society of South Central Texas requires that all applicants complete the "Application Supplement" attached to this form.

Your Name (Last, First MI) : Amt. of Scholarship

Eligibility (Non-LOMA/Family mbr., LOMA Family mbr., LOMA Member):

Mailing Address:

Street

City State Zip -

Home Phone ()-- Other Phone/Message Phone ()--

Academic Data

Name of Current Academic Institution and address:

Institution Name:

Address (city, state, zip):

Current Student status (e.g. junior, senior, graduate):

Course of Study/Major:

Expected Student Status, Fall 2008: Institution in which you will be enrolled, Fall 2008:

Grade Point Average:

Expected Completion Date of Degree program (mm/dd/yyyy):

Sources of Educational Funds Amounts:

APPLICATION SUPPLEMENT (required)

Please answer the following questions in a concise and factual manner. Your responses should be in Standard English and all three should total no more than 750 words.

1. What specific area of business do you intend to pursue after graduation from college? Will your choice include the life and health insurance industry?

2. What have been your most satisfying non-academic activities over the past five years? Could any of these contribute to the success in your eventual career?

3. What characteristic do you consider most important in a business leader? Why is this characteristic important and when is it most obvious?

Transcript Information

**Please mail an official current transcript from each post-secondary institution, which you have attended to the address below.

Lisa Villanueva

Chairperson, Scholarship Committee

LOMA Society of South Central Texas

P.O. Box 780131

San Antonio, TX 78278-0131

I certify that all statements made in this application are true, and I agree that any misstatement or concealment of facts may subject me to disqualification. I understand that all the information furnished is intended solely for the use of determining whether I qualify for the LOMA scholarship.

Signature Block Date

Submission of this form via the internet to the LOMA Society of South Central Texas is considered to be "signed" electronically. **Remember to mail official copies of your transcripts so your application may be processed in a timely manner.

BEFORE SUBMITTING, PRINT THIS PAGE AND THE CONFIRMATION PAGE FOLLOWING FOR YOUR RECORDS.

Last Updated: 06/06/08 06:50 AM .