Application for the Jon C. Ladda Memorial Scholarship

Personal Information

Name: _____________________________________________________ (First) (Middle) (Last)

Address: ___________________________________________________

              ___________________________________________________

              ___________________________________________________

Email Address: _____________________________________________

Phone: ___(____)____________________________________________

Date of Birth: _______________ Social Security Number: ____/____/____

                     Month / Day/ Year

Parental Information

Name of Parent in Military: ______________________________

Area of the Navy served (ie. aviation, submarines, surface, etc.): _____________________________________

Approximate areas/times served: _________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Graduate of the United States Naval Academy, if so, year of graduation: _______

Date of Death or Medical Retirement: ____________________________________ Military parent's SSN (for verification purposes only): ________________________ Was death or retirement in the line of duty: _______________________________

Total Parental Income (Annual)

$0 to $10,000 ______

$10,000 to $20,000 ______

$20,000 to $30,000 ______

$30,000 to $40,000 ______

$40,000 to $50,000 ______

$50,000 and over ______