THE STEVEN J by 2M2E0P7

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									               The Steven J. Mally Memorial Fund, Inc.
               2011 – 2012 SCHOLARSHIP APPLICATION

                $7,500 in Scholarships
____________________________________________________
                                 Application deadline May 4, 2012

        In July 2004, Steven J. Mally passed away in a tragic car accident. Just 23 years old,
everyone who knew him would agree that he lived more in those short years than most people
who live to 100. Steven was a well-rounded and creative individual with a dedication to his
personal education and a passion for educating others. At the time of his passing, Steven had
nearly completed a master’s program in teaching at the C.W. Post Campus of Long Island
University with plans to teach English. He prided himself on being a well-rounded individual
and in addition to his studies, was a star member of his college wrestling team, as well as an
accomplished musician and lyricist who participated in two bands simultaneously.

       In honor of Steven's legacy and his dedication to education, public service, and personal
enrichment, his friends and family have established the Steven J. Mally Memorial Fund, Inc.
The Steven J. Mally Memorial Fund will award $7,500 in scholarships to one or more
outstanding college-bound Harborfields High School senior athlete(s). All applicants must
comply with the following eligibility and application criteria. Each applicant must:

         1. Be an active student at Harborfields High School, in Greenlawn, New York in his/her
         last year of high school.

         2. Have a minimum grade point average of 80 (out of 100).

         3. Have earned at least one varsity letter during their Harborfields career.

         4. Plan to attend an accredited four-year college or university.

         5. Fill out and return the application by the application deadline.

                                      Application Procedure

         1. Applicant and applicant's parent/and or guardian must complete questions 1-12 below.

         2. Applicant must complete and attach the essay (Question 12) and, if desired, the
         optional supplemental submission from (Question 13).

         3. Attach an up-to-date high school transcript.

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         4. Applicant and/or applicant's parent/guardian must sign the completed and assembled
         application and insert it into a 9x12 envelope with the applicant's name, address and
         contact information in the upper right hand corner.

         5. Deposit the sealed envelope into the designated box in the Harborfields High School
         guidance office or send it to the address listed below. **Please note, if you choose to mail
         the sealed envelope it must arrive on or prior to May 4, 2012 to be considered.

         6. If you have any questions or comments, please feel free to contact the fund at:

                                     The Steven J. Mally Memorial Fund, Inc. at:
                                               c/o Conor McDonough
                                                  53 3rd Street #4L
                                            Brooklyn, New York 11231
                                                   (917) 575-5279
                                              MallyFund@gmail.com

                                               or visit our website at:

                                              www.MallyMemorial.org




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                                         PLEASE COMPLETE THE FOLLOWING:


         1. Name:________________________________________________________________
                     Last                    First                   Middle

         2. Social Security #: ______________________________________________________

         3. Address:

         STREET ________________________________________________________________

         CITY AND STATE_______________________________________________________

         ZIP ____________________________________________________________________

         4. Contact Information:

         HOME PHONE #___________________ALTERNATE PHONE # _________________

         EMAIL ADDRESS _______________________________________________________

         5. Sex:         M         Date of Birth ________/______/________
                                     F
                                                  Month / Day / Year
         6. High School: _________________________________________________________

         7. Expected Date of High School Graduation _________________________, 20_____

         8. Parent/Guardian Information:

         NAME:________________________________________________________________
                    Last                    First                   Middle

         ADDRESS: Same as Applicant’s

         STREET ________________________________________________________________

         CITY AND STATE_______________________________________________________

         ZIP ____________________________________________________________________

         CONTACT INFORMATION: Same as Applicant’s

         HOME PHONE #___________________ALTERNATE PHONE # _________________

         EMAIL ADDRESS _______________________________________________________


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         9. Full names of accredited colleges you have been accepted to/have applied to:

                                     Name                           City and State




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         10. Extracurricular Activities: (IF NECESSARY, ATTACH A SEPARATE
         SHEET):

         A. Sports: Harborfields High School varsity sports team membership (check all
         that apply):

   Varsity Boy's Sports      Varsity Girl's Sports
Sport               Check Sport                Check Years of Varsity
                                                     Participation
Baseball                  Basketball                 Fr     So     Ju          Sen

Basketball                           Bowling                Fr    So     Ju    Sen

Bowling                              Cheerleading           Fr    So     Ju    Sen

Cross Country                        Cross Country          Fr    So     Ju    Sen

Football                             Field Hockey           Fr    So     Ju    Sen

Lacrosse                             Gymnastics             Fr    So     Ju    Sen

Soccer                               Lacrosse               Fr    So     Ju    Sen

Swimming                             Soccer                 Fr    So     Ju    Sen

Tennis                               Softball               Fr    So     Ju    Sen

Track                                Swimming               Fr    So     Ju    Sen

Volleyball                           Tennis                 Fr    So     Ju    Sen

Wrestling                            Track                  Fr    So     Ju    Sen

                                     Volleyball             Fr    So     Ju    Sen

Other:                               Other:                 Fr    So     Ju    Sen
_________________                    _________________

Other:                               Other:                 Fr    So     Ju    Sen
_________________                    _________________




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         B. List any academic honors, awards or special achievements or recognitions:

                         Honor/Award                      Date of Receipt (if applicable)




         C. List any community volunteer activities and the length of time you have been a
         volunteer:

                               Volunteer Activity                       Length of Time




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         D. List any non-athletic extracurricular activities in which you are a member
         (include any clubs, programs, or other school-related activities):

                   Activity             Years of Participation   Leadership Positions/Offices
                                                                            Held




         E. List any other relevant activities, work experience, hobbies, etc., which you think
         might help us in evaluating you for the scholarship:




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         11. Academic Information:

         Grade Point Average (as of the most recent report card) _________________

         *********Attach an official, up-to-date high school transcript. *********

         12. Essay:

                 Steven J. Mally was an accomplished musician who wrote many songs and
         participated actively in the Long Island music scene. His profound, poetic lyrics reflected
         his thoughts and experiences. Consequently, it is appropriate that each year, the essay
         question will contain a quote from one of Steven's songs and require each applicant to
         reflect on the quote, possibly saying how it relates to their personal experiences, goals or
         ambitions. The essay will be graded for both technical writing skills and creativity.

         Question: In 500 words or less, please complete and attach a typewritten essay that
         reflects on the following passage:
                                            So I stay lost in my dreams
                                     Cause nothing ever really is as it seems
                                          It’s about time for me to leave
                                         And the one thing that I believe
                                      Is something must be waiting for me

         13. Optional Creative Submission: Steven was a creative individual who valued being
         well rounded. In addition to the essay, please feel free to submit a supplemental short
         video, piece of artwork, CD of an original musical composition, original piece creative
         writing or journalism, or other creative work which may help us learn more about your
         personality, skills and hobbies. Please keep any written work to less then 500 words.
         Any supplemental submission will be considered in conjunction with the mandatory
         essay.




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         14. Certification:

         I hereby affirm that the information provided on this form is accurate and complete to the
         best of my knowledge.


         _______________________________________________________________________
          Applicant Signature                                        Date


         _______________________________________________________________________
          Parent/Guardian Signature (if applicant is under 18 years of age) Date


                  Checklist of items to include in the completed application packet:

                                            Signed Application
                                            Transcript from High School
                                            Essay
                                            Optional Creative Submission (from question #13)




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