G.M. EMERSON MEMORIAL SCHOLARSHIP

STUDENT APPLICATION FORM

For Graduating Seniors or Students Continuing Their Education

All items must be completed.  Please type your responses.  Feel free to attach additional sheets if your responses do not fit in the space provided.

1. NAME_________________________________________

2. ADDRESS______________________________________

3. GRADE POINT AVERAGE - HIGH SCHOOL __________

                                                     COLLEGE ______________

4.  PLEASE DESCRIBE YOUR WORK/JOB EXPERIENCE DURING THE LAST FOUR YEARS.

5.  PLEASE LIST ANY SPECIAL HONORS OR AWARDS YOU HAVE RECEIVED.

6.  WHAT ARE YOUR AREAS OF SPECIAL INTEREST OR TALENTS?

7.  WHAT TYPE OF COMMUNITY SERVICE WORK HAVE YOU DONE?

8.  WHAT INSTITUTION OF HIGHER LEARNING ARE YOU ATTENDING OR PLAN TO ATTEND; WHAT COURSE OF STUDY ARE YOU PURSUING OR PLAN TO PURSUE; WHAT DEGREE DO YOU EXPECT TO EARN; WHAT ARE YOUR CAREER PLANS AFTER GRADUATING?

9.  PLEASE LIST AN APPROXIMATE AMOUNT REQUIRED TO THE FOLLOWING FOR THE NEXT YEAR:

            TUITION AND FEES _________

            ROOM AND BOARD _________

            BOOKS ____________________

PLEASE ATTACH AN OFFICIAL COPY OF YOUR COLLEGE TRANSCRIPT IF YOU ARE CONTINUING YOUR EDUCATION.

________________________________________________________________________

SIGNATURE OF APPLICANT                                                                 DATE