NORTH KINGSTOWN CHAMBER OF COMMERCE CHARITABLE FOUNDATION

8045 Post Road, North Kingstown, RI 02852 (401-295-5566)

2013 SCHOLARSHIP APPLICATION

2013 Scholarship Application Process

Listed below is the specific criteria needed for this application to be considered.

1. Open to any North Kingstown High School student or any North Kingstown resident graduating this year
from a public or private high school and accepted at an accredited 2 or 4 year institution of higher
learning.
2. Must submit two (2) - one page essays: One describing ways you showed initiative in your school-to-career
experience and/or your community service and the second essay indicating why you feel you should receive
scholarship aid.
3. A transcript of grades must be included.
4. The deadline for submission is Friday, May 3, 2013

NAME IN FULL: _____________________________________________________________________

ADDRESS:___________________________________________________________________________
PHONE NUMBER:___________________________________________________________________
FATHERS NAME: ___________________________________________________________________
MOTHERS NAME: __________________________________________________________________
GUARDIANS NAME (if other than above) _________________________________________________
NAMES OF BROTHERS AND SISTERS:

AGE

___________________________________
___________________________________
___________________________________
___________________________________

_____
_____
_____
_____

NAMES OF COLLEGES OR SCHOOLS TO WHICH YOU HAVE APPLIED, IN ORDER OF CHOICE

l. __________________________________ Accepted yes ____
2.__________________________________ Accepted yes____
3.__________________________________ Accepted yes____

no _____
no _____
no _____

COURSE YOU INTEND TO PURSUE: ____________________________________________________

(over)

EMPLOYMENT HISTORY:
1._____________________________________ How long? ____________________
2._____________________________________ How long? ____________________
3._____________________________________ How long? ____________________
LIST: a. the high school activities in which you have actively participated
b. the year(s) during which you participated
c. any office(s) you held in the activity
(a)
__________________________________
__________________________________
__________________________________
__________________________________

(b)
________
________
________
________

(c)
__________________
__________________
__________________
__________________

LIST: a. the non-school activities in which you were active

b. the year(s) during which you participated
c. any office(s) you held in the activity
(a)
____________________________________
____________________________________
____________________________________
____________________________________

(b)
___________
___________
___________
___________

(c)
_____________
_____________
_____________
_____________

List any special recognition and/or awards you have received in school or non-school related activities, e.g.
National Honor Society, athletic letter, solo and/or ensemble music awards, etc. Give the grade during which you
received the award.

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
ATTACH AT LEAST 2 LETTERS OF RECOMMENDATION WHICH YOU SENT TO COLLEGES
I hereby give permission for the screening committee to review my high school records and to speak with
appropriate staff in conjunction with this scholarship application. Every effort will be made to keep the
information herein confidential.
___________________________________________
Student Signature

_________________________
Date