ASQ North Jersey – Section 304

Larry Turbett Memorial Scholarship Application

For the Year 2017

General Instructions APPLICATION MUST BE RECEIVED NO LATER THAN MAY 1, 2017

***** SEE ASQ TURBETT SCHOLASHIP RULES *****

Please fill out the application completely. If there is insufficient space provided under any of the entries below, attach supplementary sheet(s). Additionally, please attach a copy of your most recent transcript as “Attachment A”.

Part 1 - General Information

Name / Birth Place
Street Address / Age
City, State, Zip / Email Address
Telephone No. / Sponsor Name

Part 2 Education History

A. List all Schools Attended

School Name / City / State / Year start / Year end

B. What extracurricular activities were you actively engaged in at school?

Name of Organization/Activity / Honors or Offices Held / Years

C. List other activities or hobbies you were interested in:

Name of Organization/Hobby/Activity / Honors or Offices Held / Years Participated

D. What subjects were you most interested in high school?

E. What college do you plan to attend?

3. Signature(s)

______

Signature of Applicant Name and Signature of Sponsor

______

Date Sponsor’s Membership Number

Note(s):

1. The applicant should attach a copy of his/her most recent transcript as “Attachment A”.

[If the applicant took the SAT, ACT or similar tests,AND if the scores from these tests are not reported in the transcript, please provide those test scores, separately from the transcript.]

[If the High School does not report Rank In Class on the transcript, please provide this information separately, if known.]

[If the HS does not report HSPA results on the transcript, please provide separately, if available.]

2. The sponsor should enclose a copy of his/her membership card marked “Attachment B”.

3. Applications postmarked after Monday, May 1, 2017may not be accepted.

4. The optional essay will be used as a tiebreaker in evaluating applicants.

Mail application to:

Ed May, ASQ Chapter 304 North JerseyScholarship Chair

17 Oberlin Street, Maplewood, New Jersey, 07040

Form Updated 03-05-2017