Post Graduate 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.

Post Graduate Award — $500 One-Time Award ($5,000 of insurance)
• Member of LPSCU for five (5) years with a $5,000 permanent reserve life insurance
certificate (excludes term insurance).
• Provide photocopy of Master and/or Doctorate Degree received.
• Degree must be earned within 1 year of the application deadline.
• Provide wallet size color photo.
• Application must be postmarked by September 30 following award year

Post Graduate Award Application

Name

Address

City

State

Zip

Telephone

Cell

Graduated From (Name of College)

Date of Graduation

Address

City

State

Zip

Degree In

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.

Signature of Applicant(Required)

Date

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