Benevolent Society of St. Francis
of Neresine
Scholarship Application
Applicant Name:
____________________________ ______________________________
Last First
Address: _________________________________________________________________
Number
& Street
_________________________________________________________________________
City
State Zip code
Phone: ______/_____/_______
E-mail address (optional):
__________________________________________________
Birth date: ____/____/____ Sex:
Male_____ Female_____
Society Member: Yes_________
No________
Sponsored by: ______________________________________________
Town relation: ______________________________________________
Educational
Institution Attending: ________________________________________
Scholastic Year Applying for: ________________________________________
Extra-curricular
Activities: ________________________________________________________
________________________________________________________
Signature of Applicant: ________________________________________
Signature
of Sponsor: ________________________________________
Please attach all
required material and mail to the Scholarship Committee member of your choice.