Scholarship Application

Christopher D. Corbett Memorial Fund Inc. Scholarship Application

Name *

First

Last

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Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

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Date of Birth

Age

Family Information

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Mother's Name *

First

Last

Mother's Occupation

Mother's Employer

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Father's Name *

First

Last

Father's Occupation

Father's Employer

Siblings

Please list their Names, Ages, and Schools

Academic Information

Catholic School I currently attend:

Fall incoming grade level:

Average Letter Grade (Elementary School Students):

Cumulative Grade Point Average (GPA) (High School Students Only):

**Must provide copy of current transcripts along with application**

If you will be attending a different Catholic school than your current school please indicate below. Graduating eighth-grade students may apply for the $1,000.00 high school scholarship but must list what Catholic high school they will be attending.

Catholic school I will be attending in the Fall

Financial Information

Mother/Guardian Annual Salary:

Father/Guardian Annual Salary:

Other scholarships earned for upcoming academic year:

Please detail Name / Amount

SECTION 2

Please list below the ways you are currently active in your community, or have been active during the past year. (If more space is needed, please include a separate sheet.)

Please Provide:
Organization Name
Service Provided
Dates From/To
Total Hours of Service

Community Activities

Letter of Recommendation

One letter of recommendation is required. Letter of recommendation should provide testimony of your commitment to making a difference. Letter must be written by a member of the school faculty or parish priest/deacon.

Essay

On a separate document write a 300 to 600 word essay answering the following questions:

1. How are your Catholic education and values making a difference in your life?

2. Describe an experience you had helping others and explain what made it rewarding.

*Your Essay can be attached to this form below, or emailed to: chriscorbett5k@gmail.com

Essay Document Upload

Click or drag a file to this area to upload.

SECTION 3

Certification

I certify that all information provided on this application and all supporting documents are accurate and complete. I understand that any misleading or false information will result in my application being disqualified. In addition, I give permission to the Scholarship Committee to duplicate my Application Packet for processing and evaluation purposes. I understand that the scholarship is awarded at the discretion of the Scholarship Committee.

Certification Area

Certification Signature

Date

Media Release Authorization

If selected as a scholarship recipient, I hereby authorize and give full consent for the use of my name and photograph by the Christopher D. Corbett Memorial Fund, Inc. for any and all promotional and publicity purposes. My consent shall include, but not be limited to, the publication of my name and photograph on the website of the Christopher D. Corbett Memorial Fund, Inc., its Facebook page, and any and all other social media. This authorization and consent shall continue until revoked by me in writing.

Media Release Area

Media Release Signature

Date