Name of Applicant ________________________________________________________
Address ________________________________________________________________
Name of School __________________________________________________________
Date of Birth ____________________________________________________________
Name(s) of Parent or Guardian ______________________________________________
Occupation(s) or Parent or Guardian __________________________________________
Number of brothers and sisters financially dependent on family ____________________
Names or Colleges to which you intend to apply ________________________________
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What are your career goals? _________________________________________________
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What are your hobbies, community activities and interests? ________________________
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How are you planning to finance your education? _______________________________
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On a separate sheet, please explain why you feel you are deserving of this scholarship award and what it would mean to you.
Date _________________ Signature ________________________________________
Forward this form to your Guidance Counselor for additional comments. Please include a transcript with SAT Scores and a letter of recommendation to the address below by November 1, 2010.
Michael Doherty
CMCFO Scholarship Chair
731 Grove Street
Worcester, MA 01605
