I.N. STANLEY SCHOLARSHIP

STUDENT APPLICATION FORM

NAME _____________________________________________________

ADDRESS __________________________________________________

                  __________________________________________________

RANK IN CLASS _______ of _______

GRADE POINT AVERAGE ____________

PLEASE WRITE A FEW PARAGRAPHS REGARDING YOUR NEED FOR THIS SCHOLARSHIP AND YOUR EDUCATIONAL AND CAREER PLANS AFTER YOU GRADUATE.

PLEASE LIST 3 REFERENCES:

1. __________________________________________

2. __________________________________________

3. __________________________________________

All information is complete and accurate as provided.

_______________________________________________________________

APPLICANT'S SIGNATURE                               DATE