CONNECTICUT PARKS ASSOCIATION INC.
DENNIS MALONE MEMORIAL SCHOLARSHIP
APPLICATION
NAME_______________________________________________________________PHONE_________
ADDRESS___________________________________________________________________ZIP_____
High School Attended__________________________________________________________________________
Grade Point Average_____________________ Class Rank____________________________
(enclose transcript)
I have applied to these colleges: Accepted or planning to Intended course of study
(list in order of preference) attend?
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I have already been awarded scholarship aid from these sources: (list amounts)
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I expect to finance my first year of college in the following manner:
Personal savings:_______________________________________________________________________________
Other:________________________________________________________________________________________
I expect to earn this summer:___________________________________________________________________
Does your family have any unusual financial burdens or responsibilities at present (i.e. extensive illness?)
If so, please explain:
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Has your family had any unusual financial burdens or responsibilities in the past five years?
If so, please explain:
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Father’s occupation and title:____________________________________________________________________
Employed by:___________________________________________________Years with firm:________________
Mother’s occupation and title:___________________________________________________________________
Employed by:___________________________________________________Years with firm:________________
Please check the range of family gross income:
( ) Under $10,000 ( ) $30,000-$34,000 ( ) $50,000-$59,999 ( ) $80,000-$89,999
( ) $10,000-$19,999 ( ) $35,000-$39,999 ( ) $60,000-$69,999 ( ) $90,000-$99,999
( ) $20,000-$24,999 ( ) $40,000-$49,999 ( ) $70,000-$79,999 ( ) $100,000 or over
( ) $25,000-$29,999
Student Activities: (school and/or community) Please attach your resume.
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Student Employment:
Employer #1:_________________________________________________________________________________
Brief description of duties:______________________________________________________________________
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Hours worked:_____________ Days per week:_________ Dates of employment:_______________________
Employer #2 (if any): _________________________________________________________________________
Brief description of duties:______________________________________________________________________
_____________________________________________________________________________________________
Hours worked:_____________ Days per week:_________ Dates of employment:_______________________
I know and approve of this application by my son/daughter for one of the scholarships.
Signature :_____________________________________________________________________
Print name:_____________________________________________________________________
Date:__________________________
Additional comments that will aid the scholarship committee:
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Please list three individuals, other than family, who can provide references as to your character and abilities:
Name Title Address Phone
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Please attach a brief essay about the course of study you will be in, how you chose it, and what career goals you have.