Scholarship Application for High School Seniors

Scholarship Application for High School Seniors

Mary Our Queen Parish

Scholarship Application for High School Seniors

Guidelines for Eligibility and Awards:

  1. Applicants must be active and current members of Mary Our Queen Parish.
  2. Applicants will be considered on the following grading system: Weighted 60% on parish activity, 20% on scholastic achievement, 10% on civic, extra-curricular activities, 10% community service volunteerism.
  3. All stated parish activity, scholastic achievement and volunteerism must be documented with a supervisor’s name and telephone number.
  4. All applications must be signed by the applicants, the applicants’ parent or guardian and submitted to Committee chairman, Mr. Marty Jansen, by March 15, 2016.
  5. Scholarship awardees will be notified in writing by a member of the scholarship committee and funds awarded will be payable directly to the awardees after the first semester of college has been completed successfully. (copy of the transcript must be submitted).

General Information:

Applicant Name: / Click here to enter text. /
Applicant Address: / Click here to enter text. /
Preferred Phone: / Click here to enter text. /
Preferred Email address: / Click here to enter text. /
Parent or Guardian Names: / Click here to enter text. /
College/University applied to: (Name top 3) /
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Class rank and GPA: / Click here to enter text. / Verified by: Click here to enter text.

Parish involvement: Please list all activities and length of time you were involved, if known (attach addition sheet if needed)

Activity / Grade / Hours/week / Weeks/year / Supervisor Name/phone
EX: CCD / 9-10th / 1 / 25 / Mr. Huntley
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text.
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Community service and Volunteer Activities. Please list and describe any service or volunteer work you’ve been involved in. (Non-parish related)

___Click here to enter text.___

Extra-curricular school or civic activities.Please List the school activities you’ve been involved in over the past 3 years.

Name of Activity / Grade in School / Supervisor/Phone
Ex: Key Club Bottle Drive / 10-12th / Mrs. Jones (xxx-xxx-xxxx)
Click here to enter text. / Click here to enter text. / Click here to enter text.
Click here to enter text. / Click here to enter text. / Click here to enter text.
Click here to enter text. / Click here to enter text. / Click here to enter text.

Provide for the Scholarship Committee: (a) a statement of your faith, (b) how you intend to continue growing in your faith as you mature, and (c) your views on God’s will for your life.

___Click here to enter text.___

I attest that all information presented in this application for scholarship is true and factual to the best of my knowledge.

Applicant’s Signature:***

Click here to enter text.

Parent/Guardian’s Signature: ***

Click here to enter text.

Please mail your completed application to:

Mr. Martin Jansen

58 Dale Drive

Plantsville, CT 06479

Deadline for Submission, March 15, 2016.

***NOTE: By signing in font above, you agree that your e-signature is the equivalent to your actual signature

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