John P. Burke Memorial Fund Application

John P. Burke Memorial Fund Application

I hereby apply to the John P. Burke Memorial Fund for scholarship assistance.

PLEASE PRINT OR TYPE

Name ___________________________________________________________________________________

FIRST MIDDLE LAST

Address _______________________________________________________________________________

NUMBER & STREET CITY & STATE ZIP

Telephone Number ____________________________ Date of Birth ___________________________

Email Address ________________________ Number Living at Home ___________________

Number of Children in Family ____________ Number of Children (other than applicant) in College________

Father’s Or Guardian’s Name _________________________________________________________________

Father’s Occupation ________________________________________________________________________

Mother’s Or Guardian’s Name ________________________________________________________________

Mother’s Occupation _______________________________________________________________________

Parent’s Own Home? ______ Estimated Value ______________ Amount Owed ____________________

Rent Home? _____ Monthly Rent ____________

Number Cars? ______ Make(s) & Year(s) _______________________________________________________

Sponsoring Club(s) _________________________________________________________________________

Position Worked ____________________________________________ Number of Years Worked __________

High School Attending: _______________________________________________________________________

College Attending, If applicable _____________________________________ Graduation Year ____________

Have you ever enrolled in another college? (name) ____________________________ When?_______________

Were you ever dismissed from a school? _________ Name of School _________________________________

Reasons for dismissal _______________________________________________________________________

Were you ever placed on probation? ____________ Name of School _________________________________

Reasons for probation ______________________________________________________________________

Scholastic Aptitude Tests Scores: Verbal ______________ Math _____________Essay ________________

Other Scores (AP, etc.) ____________________________________________________________________

Class Rank ______________________ Size of Class _______________________

I have applied to the following college(s):

College Accepted? Estimated Costs Financial Aid Received

1. ____________________________________________________________________________________________

2. ____________________________________________________________________________________________

3. ____________________________________________________________________________________________

4. _____________________________________________________________________________________________

Have you applied for other scholarship and aid? ______________

To what organization(s): ________________________________________ Amount Awarded:___________

________________________________________ ___________

What profession do you intend to follow?

1. ____________________________________________________________________________________________

2. ____________________________________________________________________________________________

3. ____________________________________________________________________________________________

What special recognition have you received for excellence in school work, such as honors, prizes, scholarships?

_____________________________________________________________________________________________

What fields of study interest you most?

_____________________________________________________________________________________________

List community or other organizations not connected with your school in which you have been active, and indicate those in which you have held responsible positions:

_____________________________________________________________________________________________

List activities in which you have taken part, such as representing your school in academic and athletic interscholastic contests, editorships, entertainments and holding responsible offices in students’ organizations and responsible positions in school functions. Comment on any special recognition you have received.

_____________________________________________________________________________________________

Indicate your hobby, if you have one

_____________________________________________________________________________________________

In what ways have you contributed toward your financial support while in high school or college ? ___________________

_____________________________________________________________________________________________

Will you seek employment to contribute toward your financial support :

1) while in college? _________________________________________________________________________

2) during the summer? ______________________________________________________________________

Estimated Summer Earnings _______________________ Your Bank Savings _________________________

A VOLUNTARY SUBMISSION OF A PHOTOGRAPH WOULD BE APPRECIATED.

By signing below, we certify that the information in this application is accurate and complete to the best of our knowledge and belief.

Applicant’s Signature _______________________________________________ Date ________________

Parent/Guardian Signature ___________________________________________ Date ________________

Deadline Date for Submission for Completed Application, Requested Forms and Information is April 15th.

Mail to:

John P. Burke Memorial Fund
1 Button Hole Drive
Suite 2
Providence, RI 02909