Application for

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Application for

Carrier Scholarship

The Record-Journal Publishing Company Applicants must have been Record-Journal carriers for at least two full years. Length and quality of service is considered.

1. Complete this application as fully and accurately as you can.

2. Attach a photograph (about 2x3) of yourself.

3. Have your guidance department submit your grade transcripts.

4. Submit two letters of recommendation, one from a teacher and one from a person other than a teacher or relative.

5. Submit an essay detailed within the application, item #17.

6. Submit the Financial Aid Form (F AF) and any notification received, item #22.

All data received will be treated as confidential by the Committee. Please submit the application before the deadline. Send transcripts, letters, FAF and any other pertinent information to: The Scholarship Committee, Record-Journal, 11 Crown St., Meriden, Connecticut 06450.

The deadline is April l't, Incomplete applications will not be considered.

1. Name ............................................................................................................................ . (last) (first) (middle) Home address ............................................................................. Phone .............................. . (street) (town) (zip) Email address ............................................. Cell Phone (optional) ........................................... .

2. Place of birth ...........................Date of birth .................. Social Security # ............................................ ..

3. Father's name in full .......................................................................................................... .

Father's occupation and name of employer............................................................................... .

4. Mother's name in full ......................................................................................................... .

Mother's occupation and name of employer. ................................... .'......................................... .

5. Are you related to someone who is an employee of the Record-Journal? ........................................................ ..

6. List the years you were a carrier for the Record-Journal. ................................................................ .

7. List all schools you have attended, high school and beyond. Begin with the most recent.

8. Give the name and address of a teacher whose class you have taken and from whom information regarding you can be obtained ............................................................................................. . (name) (address) 9. GiYe the name and address of a person other than a teacher or relative from whom information about you can

be obtained ................................................................................................................. ;, (name) (full address) 10. What studies have you liked best during your high school (or current school) years? ........................... .

What special recognition, if any, have you received for excellence in school work such as honors, prizes or scholarships? ................................................................................................................ .

11. SAT Scores: Verbal ............................. Math ........................... Writing ............................. .

12. In what field do you plan to major in college? ......................................................................... .

13. List in order of preference the colleges to which you have applied and any answers you have received.

14. If you have done any special work in your general area of interest during the past few years, either under the supervision of a teacher or independently, please explain briefly ............................................... .

15. List your extra-curricular activities and school-required community service. Include any offices held, awards or special recognition you have received in connection with them ........................................ ..

16. List any community service activities outside of school in which you have taken part. ................... .

17. Write an essay addressing one of the following questions: a. Have you a definite ambition or goal for your life's work? What specific things are you doing to realize this goal? b. What do you consider to be America's greatest need today, and in whal way do you believe that your life can help in part to meet it? c. What event has had the single greatest influence on your life? Why? d. How can or should a balance be struck between the public's right-to-know and the individual's right to pri vacy in the American journalism? How do the First Amendment and the Freedom of Information law fit in?

18. List recent jobs .............................................................................................. ..

Financial Information

,ord路Journal scholarships are awarded, in part, on need. In order to judge this need, the Committee requires that you .aclude specific figures when providing the following information. If circumstances dictate an explanation, please submit it on a separate sheet of paper.

19. Give names and ages of brothers, sisters, or others who are wholly or partially dependent on your parents, and name of school (if any) they attend: Name ...............................................Age ......... SchooL .....................................Grade .......................... .

20. Father's income from trade, business or profession for past tax year ........................................................... .

21. Mother's income from trade, business or profession for past tax year. ......................................................... ..

22. Please submit a copy of your Financial Aid Form (FAF). What amount does this form indicate your family's estimated contribution should be toward the cost of your education? $ .......................................................................... ..

23. What Amount of money will you require for college next year?

Tuition and fees .........................................

Transportation .......................................... .

Room and board ........................................

Pocket money ........................................... .

Books..... ......... ..... ............... ..................

Total: $ .................................................. .

24. How do you intend to meet these expenses? (The total amount in question #23 may not agree with the total listed in #24)

From family income ..................... , ............ .

Personal savings (figure IA of your present savings

From family assets .................................... .

for each year of college) ..................................... .

Scholarships (List below) ............................. .

Other (ex: college tuition reduction) ....................... ..

Explain other. ............................................ .

Total $ .................................................... .

25. To what other scholarship agencies, local or otherwise, have you applied for financial assistance?

Applicant's signature .................................................................... Date ............................ ..

CERTIFICATE

(To be signed by parent or guardian)

Place photograph here

1. ............................................... :..................................... .

(name of parent or guardian)

of .................................................................................... . (address) As the parent/guardian of the applicant, I do hereby certify that I have read the applicant's answers to the questions 19 through 25, and that to the best of my knowledge and belief they are correct.

(Signed) ........................................................................... ..

(Date) ............................................................................... .