ANASTASIA (ANN) AND GEORGE C. DIMITRAKIS MEMORIAL SCHOLARSHIP

APPLICATION for SCHOLARSHIP

All applicants must complete this scholarship application form and submit it together with all required documentation by May 16, 2014. Please type all information. Mail completed application to: George S. Dimitrakis Memorial Scholarship, c/o St. Athanasius the Great Greek Orthodox Church, 4 Appleton St., Arlington, MA 02476.

APPLICANT:

Full Name (Last, First, Middle):

Home Address (Street, City, State, Zip):

Contact (Telephone, Fax, E-mail):

Place of Birth (City, State, Country):

Date of Birth:

Gender: MALE FEMALE

PARENT(S) OR GUARDIAN:

Name (Father, Mother, Guardian):

REQUIREMENTS AND ADDITIONAL INFORMATION:

1. STEWARDSHIP (pleasecheck years in which stewardship requirement was fulfilled)

 20122013 2014

2. Name and address of high school.

Name:

Address, City, State, Zip:

3. Rank in high school graduating class: # _____ out of_____.

4. Unweighted GPA* ______Weighted GPA* ______

*if applicable

5. Please give the names and addresses of two persons (not relatives and not members of the

Scholarship Awards Committee) who are providing letters of recommendation. At least one letter must be from a teacher or educator in your high school.

Ref. 1 (Name, Telephone, Address, City, State, Zip):

Ref. 2 (Name, Telephone, Address, City, State, Zip):

6. List all extracurricular activities, including those related to the Greek Orthodox Church

(specify years of participation, elected offices and years as officer).

Academic Activities:

Activity / Grade level / Approx. Time Spent / Positions held,
Honors won
9 / 10 / 11 / 12 / Hours per week / Weeks per year

Church Related:

Activity / Grade level / Approx. Time Spent / Positions held,
Honors won
9 / 10 / 11 / 12 / Hours per week / Weeks per year

Extracurricular Activities (including jobs, internships, volunteer work):

Activity / Grade level / Approx. Time Spent / Positions held,
Honors won
9 / 10 / 11 / 12 / Hours per week / Weeks per year

7. List all scholastic honors.

Honor / Grade level
9 / 10 / 11 / 12

9. A list of the colleges to which you have been accepted. Please indicate which is your first choice and your anticipated major.

8. An essay (no more than 300 words) that explores the relationship between your Greek Orthodox faith and your intellectual/academic aspirations.

Your typed application package should be submitted in complete form, and must include the following (see below), all of which should be sent directly to:

George S. Dimitrakis Memorial Scholarship

c/o St. Athanasius the Great Greek Orthodox Church

4 Appleton St., Arlington, MA 02476.

The following should be submitted directly to George S. Dimitrakis Memorial Scholarship:

• Two letters of recommendation (signed, sealed, and signed across the seal). Letters must be submitted by their authors directly to the St. Athanasius Greek Orthodox Church.

• Official high school transcripts (sealed) sent directly from your high school to St.

Athanasius the Great Greek Orthodox Church.

All information is subject to validation and will remain confidential.

I hereby certify that the information supplied herein

is correct and true, to the best of my knowledge.

Applicant’s Signature & Date:

______