LCBA - Life Insurance with a Conscience

Elderhostel Scholarship

Overview Twelve scholarships of $200 are awarded each year via a lottery, with three (3) scholarships being awarded each quarter. You may apply each quarter however, only one scholarship per applicant per year. Applicants may attend any program accredited by Elderhostel, Inc, 11 Avenue de Lafayette, Boston, MA 02111-1746. Eligibility Requirements Applicant must be 55 years of age as of the application deadline. Applicant must be a benefit member or be the natural or legally adopted child or granchild of a benefit member. The LCBA life or annuity certificate, qualifying the applicant, must be issued no later than the application deadline. Be enrolled in a program listed in the Elderhostel program guide or on their website at www.elderhostel.org Applicant must complete the approved application form below or click here to print a copy. Form must be received or submitted via the electronic form below by: o December 31 for the April 1 drawing o March 31 for the July 1 drawing o June 30 for the October 1 drawing o September 30 for the January 1 drawing You must include a photo of yourself with your application Scholarship Process Three (3) scholarships will be awarded on each of the drawing dates listed above. A short essay is required but NOT judged. LCBA will screen applications for the eligibility requirements. Scholarships will be awarded by random drawing by an LCBA National Officer. Selections will be final. Scholarship recipients will be notified by the 15th of the month in which the scholarship is awarded. Announcements will be made in direction. Payments are made directly to Elderhostel, Inc. LCBA reserves the right to modify, suspend, or terminate this program without prior notice. Such action would not affect the scholarships in process. To Apply Complete the scholarship application below or click here to print out a copy to mail. If sending a hard copy, don't forget to write a 50 word essay on ?How Elderhostel attendance will benefit me? and a picture and send or fax by the last day of the month of the previous quarter. (see above) Elderhostel Scholarships ~ LCBA ~ PO Box 13005 ~ Erie, PA 16514-1305 ~Fax 814-453-3211
	* This field is mandatory
First Name *
Last Name *
LCBA Qualifying Certificate
Insured Name (If other than applicant)
Relationship of Insured to Applicant
Address *
Address 2
City *
State *
Zip *
Gender
Date of Birth *
Phone *
Email *

Attach your picture
.jpg, .gif, .tif, .bmp only. 400K max. You MUST rename the file with applicant's full name. ie. johnjones.jpg - If you are not attaching your photo, please provide a hard copy to the address above.

	Elderhostel Information
Elderhostel Program Name
Dates to Attend
Address 1
Address 2
City
State
Zip
Elderhostel Phone
Program Cost

Write a 50 word essay on: "How Elderhostel attendance will benefit me."

The LCBA Privacy Pledge The LCBA will not use the member information obtained in this online scholarship application for any purpose outside of the scope of the LCBA scholarship program. The information provided will not be given or sold to any other companies or organizations. As a scholarship winner, I hereby (or parent or guardian for those under the age of 18) give my permission to the Loyal Christian Benefit Association to use my name, photograph, and biographical information in publications or promotional pieces produced and distributed for the Elderhostel Scholarship program by the Loyal Christian Benefit Association, including those on the world wide web. I understand that I will not be compensated for the use of any photographs or information. I also understand that I am not obligated, as an LCBA member, to give the use of my name, photo, or biographical information. Parent or Guardian: Please Type Your Name and Today's Date in the Boxs Below.

Name *
Date *

The LCBA Privacy Pledge