2012MarcyScholarshipPacket

							                   MARCY CHAMBER OF CO MMER CE
                     SCHOLARSHIP APPLICATION



_______ / _______ / _______
Date of Application


Full Name (please print): _________________________________________________________
                                First              Middle              Last

Home Address: _________________________________________________________________
                     Number and Street                            City
______________________________________________________________________________
       State               Zip Code                  Home Phone

Date of Birth: _____ / _____ / _____    Expected Date of Graduation: _____ / _____ / _____

Name of High School or College Now Attending: ______________________________________

Have you previously applied for this scholarship? __________     If so, when? ______________

Name in order of preference the three colleges you wish to attend:

College                                Location (City and State)
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


Name of parent who is currently employed by the direct Chamber member. (The business must
also have been a Chamber member for at least one year.):

_____________________________________________

Name and Address of Member Business: _____________________________________________

______________________________________________________________________________

______________________________________________________________________________
                          Marcy Chamber o f Commerce
                              Scholarship Award

                                   PROFILE SH EET
Use the space provided or a separate sheet of paper if needed.



What is your intended degree program or course of study?


Why are you choosing this field?


What are your career and life goals?


What do you do for fun?


Where do you see yourself being 10 years from now?


List your high school activities and indicate whether during your Sophomore, Junior or Senior
year:

Academic Honors: ______________________________________________________________

Offices Held: ___________________________________________________________________

Music/Art: _____________________________________________________________________

Athletics: ______________________________________________________________________

Clubs: ________________________________________________________________________

How have you contributed to your community? ________________________________________

______________________________________________________________________________

List ways you have earned money: _________________________________________________

______________________________________________________________________________

What activities have contributed most to your development? Why? ________________________

______________________________________________________________________________

What do you like about the Town of Marcy? __________________________________________

______________________________________________________________________________
                    CERTIFICA TION O F IN FORMA TION




FR OM P AR E N T:

I certify the following to be true and correct.

The scholarship applicant is a dependent student who receives financial assistance from me.




_______________________________________                    ___________________________
Parent’s Signature                                         Date




FR OM A PP LIC A N T:

I certify the information I have provided in the application form to be true and correct.


________________________________________                   ________________________________
Applicant’s Signature                                      Date
                      Announcing the 2012
           Marcy Chamber o f Commerce Schol arship Award
The Marcy Chamber of Commerce is pleased to offer a $750 scholarship award to a deserving
student. To qualify, the recipient or the recipient’s parent must be employed by a member of the
Marcy Chamber of Commerce. Previous recipients are also eligible to reapply. A student’s grade
point average is one of the major determining factors in selection of this award.

The following information and materials are to be sent to the Marcy Chamber of Commerce at the
address below. (Application information is confidential and will be evaluated only by the
Chamber’s Scholarship Committee.)

    1. Complete the “Scholarship Application” and “Profile Sheet.”

    2. Request that your high school or college send a transcript of your academic record to the
       Marcy Chamber of Commerce by May 11. The transcript must include your grades for
       the F ALL ter m.

    3. Obtain “Certificate of Employment” letter from the Marcy Chamber of Commerce
       business member stating the starting date of employment (for you or your parent) with
       the firm. The firm must have had a direct membership with the Marcy Chamber of
       Commerce for at least one year prior to the date of the application.

    4. Mail this completed application form (include additional pages of information if needed)
       and the verification of employment to the Marcy Chamber of Commerce by May 11,
       2012. Applications received after this date will not be considered.


    Employer (Chamber Member): ___________________________________________

    Applicant’s Name: _____________________________________________________

    Relationship to Member Business: ________________________________________

    All application materials must be received by May 11, 2012. Mail to:

    Marcy Chamber of Commerce
    Attention: Scholarship Committee
    P.O. Box 429
    Marcy, NY 13403