Catholic High School Award Application

Applicants must meet all criteria and provide data indicated to be
eligible. Incomplete applications or data requirements will not be
considered. All materials become the property of LPSCU and will not
be returned.

Catholic High School Award — $300 One-Time Award
• Member of LPSCU for two (2) years with $2,000 permanent
reserve life insurance certificate (excludes term insurance).
• Must be Catholic High School freshman, sophomore, junior or
senior in the fall of Award year
• Provide wallet size color photo.
• Application must be postmarked by June 30

Catholic High School Award Application

Full Name

Address

City

State

Zip

Telephone

Phone

Attending/Will Attend (Name of Catholic High School)

City

State

Zip

Class attending during Award Year:

Freshman

Sophmore

Junior

Senior

I hereby certify that statements made herein are complete and correct to the best of my knowledge and belief. I have complied with the Application Guidelines for LPSCU Educational Benefit as set forth on the reverse side of this application. Also, I will return any funds awarded to me if I decide not to attend or if I drop out of the Catholic Highschool School I have submitted herewith.

Signature of Applicant(Required)

Signature of Parent/Guardian(Required)

Date

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