The University of DeMolay Scholarship Application

This is the official 2019 scholarship application for The University of DeMolay presented by Missouri DeMolay. Please fill it out completely and accurately.

The University of DeMolay will take place July 15th - 20th at the Cedar Creek Conference Center in New Haven, Missouri.

Being a participant at The University of DeMolay is a privilege and an honor. Careful review of applications will be made. Applicants who are selected to be granted a scholarship to attend will receive further instructions and forms to be signed by the Applicant, their Parent(s)/Guardian(s) as well as their Chapter Advisor(s), and for out-of-state applicants, their Executive Officer's signature.

By checking this box, I attest to understanding that while this event does have some indoor 'classroom-style' sessions, the most important experience of the Conference is the Brotherhood gained through leadership and team building activities.
By checking this box, I attest to understanding that this form constitutes an application and does not guarantee admission.
Personal Profile Information
First Name:
Last Name:
Date of Birth:
Shirt Size:
Address:
City:
State:
Zip Code:
Home Phone:	(xxx) xxx-xxxx
Email:
DeMolay Career Information
Chapter:
Chapter Advisor's Name:
Chapter Advisor's Email:
Current Office:
Received Initiatory Degree?	Date:
Received the DeMolay Degree?	Date:
Obligations Turned In?
Past Master Councilor?
Current LCC Level:	0 1 2 3 4 5
Honors and Awards: check all that apply	Founder's Membership Award Blue Honor Key Past Master Councilor's Meritorious Service Award Representative DeMolay Chevalier
Number of Members Recruited:
Previous Leadership Program Experience:	Note: preference will be given to young men who have NOT attended in prior years.
Please list any and all parts known from memory of the DeMolay Ritual or Monitor of Ceremonies:
Personal Analysis
Why would you be a good choice to attend?
If selected to attend, what do you hope to gain while in attendance?
What do you see as your three strongest leadership characteristics?
What DeMolay program would you like to improve and how?
Health/Medical Information
Health Issues:	Sinus Trouble Fainting Appendicitis Cramps in Water Allergies Frequent Colds Hernia (Rupture) Throat Infections Diabetes Convulsions Ear Trouble Heart Disease Epilepsy Autism ADD / ADHD Sleep Apnea
If any health issues are checked, please describe in detail:
Other illnesses or issues not checked above that DeMolay should be aware of:
Are you currenlty under care for any illness or injury? If so, explain in detail:
Have you had any surgeries or significant injuries in the past 12 months? If so, explain in detail:
List any and all medications currently being taken:
List any and all known allergies:
List other conditions or concerns we should be aware of:
Emergency Contact Information
Emergency Contact #1 (Parent):
Emergency Contact #1 Phone 1:
Emergency Contact #1 Phone 2:
Emergency Contact #2 (Other):
Emergency Contact #2 Phone 1:
Emergency Contact #2 Phone 2:
Insurance Information
Insurance Carrier:
Insurance Policy #:
Relationship to Insured:
Insurance Company Phone #:
Primary Care Physician Name:
Primary Care Physician Phone #:
Final Submission
By checking this box, I hereby attest that the information provided herein is representative of me and that every field of data has been answered thoroughly and truthfully.
By checking this box, I hereby attest that I have permission granted from my Parent(s)/Guardian(s) and Chapter Advisor(s) [and for out-of-state applicants, my Executive Officer] to submit this scholarship application. Furthermore, I, and they, agree to endorse all necessary forms should I be selected to receive a scholarship to attend The University of DeMolay.

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This is the official website of Missouri DeMolay and acknowledges the authority and
yields allegiance to DeMolay International, of which Frank S. Land was the founder.