Grade School Award Application

(K through 8 Grade)
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 Grade School Award — $150 One-Time Award
• Member of LPSCU for two (2) years with $2,000 permanent
reserve life insurance certificate (excludes term insurance).
• Must be enrolled in a Catholic Grade School in the fall of award
year.
• Provide wallet size color photo.
• Application must be postmarked by June 30

Grade School Award Application

Full Name

Address

City

State

Zip

Telephone

Phone

Attending/Will Attend (Name of Catholic Grade School)

City

State

Zip

Grade attending during Award Year:

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 Grade School I have submitted herewith.

Signature of Parent/Guardian(Required)

Date

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