Prefer to submit a physical copy of this application? Download the PDF here: Application PDF Please enable JavaScript in your browser to complete this form.Christopher D. Corbett Memorial Fund Inc. Scholarship Application Name *FirstLastLayoutAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail *LayoutDate of BirthAgeFamily Information LayoutMother's Name *FirstLastMother's OccupationMother's EmployerLayoutFather's Name *FirstLastFather's OccupationFather's EmployerSiblingsPlease 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 FallFinancial Information Mother/Guardian Annual Salary: Father/Guardian Annual Salary: Other scholarships earned for upcoming academic year:Please detail Name / AmountSECTION 2Please 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 ActivitiesLetter 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 3Certification 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 AreaCertification SignatureDateMedia 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 AreaMedia Release SignatureDateSubmit