APPLICATION CHECKLIST
_______ Application Completed
_______ Application Signed by Parent/Guardian
_______ Short Answer Questions Completed
_______ College Essay Enclosed
_______ Optional Letter of Recommendation Enclosed
_______ Optional Photo Enclosed
_______ Application Signed
_______ Postmarked By May 1 st
to Be Entered To Win a $100 Gift Card & $1000 Scholarship
_______ Mailed to
Maryann Loprete Memorial Foundation
RE: Scholarship
90 Birchwood Road
East Hartford, CT 06118
Maryann Loprete Graduating from CCSU

2015 - 2016 SCHOLARSHIP APPLICATION
Scholarship Applicant’s Name: __________________________________________________________________
Address _____________________________________________________________________________________
Date Of Birth: ______/______/________ Age: ___________ Male/Female Email: ___________________________
I. FAMILY INFORMATION
Name
Occupation
Father
______________________________
______________________________
Mother
_____________________________
_____________________________
Applicant resides with: _______ Both Parents _______ Father _______ Mother _______ Other_______
Will you be the first one in your family to attend college?_______ Number of Brothers: ______Sisters: _______
Are any of them attending Tech school or college? _______ If so, what school?_________________________
If you feel that the Scholarship Committee should be aware of any special family or personal circumstances , please include this information in the space below.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
II BIOGRAPHICAL INFORMATION
List School Activities And Memberships (Sports, Drama, Dance, Music, Leadership, Honor Societies, Etc.)
Activity/Membership Years Position
_________________________________ _________ ______________________________
_________________________________ _________ ______________________________
_________________________________
_________________________________
_________
_________
______________________________
______________________________
2 | P a g e
Mail Application to:
Maryann Loprete Memorial Foundation
RE: Scholarship
90 Birchwood Road
East Hartford, CT 06118

Community Activities (Include Community Service, Volunteer Work, And Any Church-Related Activities)
Activity Years Position
______________________________ _____________________________________ ________
_____________________________________ ________
_____________________________________ ________
______________________________
______________________________
List Any Honors, Awards, Or Special Recognition Received
(a) In School: ____________________________________________________________________________________
__________________________________________________________________________________________________
________________________________________________________________________________________________
(B) Out Of School:_________________________________________________________________________________
__________________________________________________________________________________________________
________________________________________________________________________________________________
List your Interests, Hobbies, or Special Skills: ___________________________________________________________
__________________________________________________________________________________________________
________________________________________________________________________________________________
List any employment or nonprofit work you have done.
Employer Approximate Dates Weekly Hours
List any chores you have to do to help your parents or siblings.
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
3 | P a g e
Mail Application to:
Maryann Loprete Memorial Foundation
RE: Scholarship
90 Birchwood Road
East Hartford, CT 06118

III. College And Career Plans
Please List The Colleges You Have Applied To And /Or Have Been Accepted To. (Indicate By * If You Were Accepted).
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
Planned College Major________________________________________________________________________
Planned College Minor________________________________________________________________________
Planned Future Career________________________________________________________________________
Please Attach Your College Essay To This Application.
I certify that all of the information included in this application has been completed by me and is, to the best of my knowledge, accurate and correct. If I am chosen to win this scholarship or gift card, my name may be used by the
Maryann Loprete Memorial Foundation to notify foundation members and donors of my scholarship award or gift card win. I may also be asked to take a photo to be posted on the Maryann Loprete Memorial foundation website or other communications. We respect your privacy so if you wish to remain anonymous please let us know in a written statement and enclose it with your application and we will NOT include your name or photo in any of our marketing materials.
______________________________________
Applicant’s Signature
______________________________________
Today’s Date
______________________________________
Parent or Guardian Signature
______________________________________
Today’s Date
Visit our website to learn more about our foundation www.MaryannLoprete.org
. If you would like to donate some of your time to our foundation or if you have any additional questions about this application simply contact Mickey and she will be happy to assist you. You can email her directly Mickey@MaryannLoprete.org,
4 | P a g e
Mail Application to:
Maryann Loprete Memorial Foundation
RE: Scholarship
90 Birchwood Road
East Hartford, CT 06118

IV. SHORT ANSWER QUESTIONS
Use additional sheet if necessary.
1.
Why should we give this scholarship money to you?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2.
Who has been the most influential person in your life and why?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5 | P a g e
Mail Application to:
Maryann Loprete Memorial Foundation
RE: Scholarship
90 Birchwood Road
East Hartford, CT 06118