2011 Carter Mario Injury Lawyers “Arrive Alive” Scholarship Application Please mail your application to Carter Mario Injury Lawyers, 158 Cherry Street, Milford, CT 06460, postmarked no later than March 25, 2011, along with a copy of your high school transcript and your essay or video presentation. * All personal information provided will be kept strictly confidential.* * Mandatory attendance is required of all winners to attend a scholarship presentation the week of May 2, 2011. Time to be announced.* Applicant Information (Please attach a recent photo Name __________________________________ of yourself here) High School _____________________________ Home Mailing Address ____________________ City ____________ State_____ Zip __________ Home Phone # ___________________________ E-mail Address __________________________ Date of Birth ____________________________ Gender: ____ Male ____ Female GPA: ____ SAT: ____ Math ____ Writing ____ Critical Reading ____ Maternal Information Mother’s Full Name _____________________________ Mother’s Address _______________________________ Mother’s Home Phone # __________________________ Mother’s E-mail Address _________________________ Mother’s Occupation ____________________________ Paternal Information Father’s Full Name _______________________________ Father’s Address _________________________________ Father’s Home Phone # ____________________________ Father’s E-Mail Address ___________________________ Father’s Occupation _______________________________ Activities and Community Involvement Please list all athletic activities you have participated in during your high school career. Sports: Letters won: Special Awards or Achievements: School Activities Please list all school activities in which you have participated during your high school career including clubs, student government, and other school organized events. Activities: Positions of Leadership: Special Awards or Achievements: Community and Religious Involvement Please list any religious and community activities in which you have been involved during your high school career. Activities: Positions of Leadership: Special Awards or Achievements: Employment Please list any employment you held during your high school career. Employer: Position Held: Brief Job Description: Dates of Employment: Academic and Professional Pursuits What field of study do you plan to pursue? Please list all colleges and /or universities you have applied to or plan to apply. Include Name, City, State, and Status of Application for each. Presentation Content & Instructions Written essay, video, or graphic presentation is acceptable. (Essay: approximately 500 words. Video: 2-5 minutes. Please submit with application.) Cell Phone Distracted Driving, (defined as when motorists use a cell phone to call or text while behind the wheel), is currently playing a major role on Connecticut’s highways. With technology advancing at an astronomical rate, cell phones have become the right hand of today’s youth. The National Safety Council has estimated that 1 million people are chatting behind the wheel at any given moment. It is now fair to say that the combination of texting and driving is becoming as lethal as getting behind the wheel intoxicated. Base your Arrive Alive submission on the following fictional scenario: Carter Mario is asking for your help to prepare a presentation to your graduating class on the dangers of distracted driving that will make them not want to get behind the wheel with a cell phone. You may submit a written essay, a video, a graphic presentation, etc. Choose whatever format best supports your thoughts and ideas. Think outside the box. What you create could positively impact Connecticut’s response to Distracted Driving, help to shape future legal actions, and most importantly save lives. All submissions will be judged by Carter Mario and his staff of attorneys. The top 10 winners will each be awarded a $1,000.00 scholarship check made out to the college they will be attending. Honor Pledge I completed this application on (date) ______________. The answers above are true to the best of my knowledge. The essay response is my own work. Signature of Applicant ________________________________ Carter Mario Injury Lawyers thanks you for making a difference in our community. Good luck to all our applicants!
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