The Meghan P. Birdsall Scholarship Fund

MEGHAN P. BIRDSALL MEMORIAL SCHOLARSHIP
APPLICATION FORM

Please print out, then type or print your personal information in the appropriate spaces.
Or follow this format, if you prefer to use your computer to prepare your application.

Student's Full Name ____________________________________________ Date of Birth ____________

Home Address ________________________________________________________________________

Telephone ________________________________ Email ______________________________________

School ______________________________________________________________________________

Name of Father
or Guardian _________________________________ Name of Mother ___________________________

Occupation _________________________________ Occupation _______________________________

Business Name _____________________________ Business Name ___________________________

Business Address ___________________________ Business Address _________________________

___________________________________________ _________________________________________

College you are planning to attend ____________________________________________________

Address _____________________________________________________________________________

_____________________________________________________________________________________

Major _______________________________________________________________________________

Estimated Cost: Annual Tuition $ ___________ Room/Board $ ___________ Total $ ____________

List your Extracurricular/Co-curricular School Activities / Clubs / Organizations

Name of Organization / Club / Activity Length of Time Position

________________________________________ ________________ ___________________________

List Any Community Service You Have Performed During the Last Four Years

Specific Type of Service Length of Time

______________________________________________________ _____________________________

References (Names of People Who Can Verify the Information Listed on the Application

Names Telephone Number

______________________________________________________ ______________________________

List Any High School Sports in Which You Have Participated

Sport Position Played

____________________________________________________ ________________________________

List Any Special Awards, Honors, Achievements, or Recognitions You Have Received Either in School or Within the Community

Award Given By Year Received

________________________________________ ____________________________ _______________

Outside Employment Record

Name of Company Type of Business Dates Employed

________________________________________ ____________________________ _______________

List Brother/Sister Age Living Home College Year Graduated Occupation

________________ ____ qYes q No ________________ _____________ _____________________

School Grade Record - Please Attach a Copy of Your High School Transcript (Include Any Teacher or Mentor Recommendations)

Statement of Financial Need

The purpose of this statement is to offer you an opportunity to provide the scholarship committee with specific and relevant information that would enhance your claim for financial aid. The Meghan P. Birdsall Scholarship is need-based. It is important that a financial need exists. Please provide, and document, your family's income including page one of your family's Income Tax Return. Clearly explain any other issues that will make it difficult for you to meet your financial obligations for college. Please type your statement on a separate sheet.

Essay Question

Please answer the following question in 300 words or less. Type your essay on a separate sheet. In today's society what single issue concerns you the most, and what meaningful contribution will you make?

Please Attach a Photograph of Yourself

Please do not staple. Affix with glue stick or two-sided tape. Recipient's picture will appear on the website; www.megbird.org

Signature of Applicant _____________________________________________________________

Signature of Parent/Guardian _______________________________________________________

Date _________________

SUBMIT YOUR APPLICATION TO THE GUIDANCE DEPARTMENT AT WEST ESSEX HIGH SCHOOL BY APRIL 15TH