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330 McBaine Avenue ! Staten Island, New York 10309 ! telephone: (718) 966-0765 ! www.siusbc.org
 STATEN ISLAND USBC ASSOCIATION
CONTINUING EDUCATION SCHOLARSHIP APPLICATION – 2008-2009

REQUIREMENTS

1. Must be 27 years of age and out of school for at least 2 years.

2. Must be an adult member of the Staten Island USBC Association.

Applicant’s Name________________________________________________________________________
LAST FIRST MIDDLE PHONE NUMBER

Address _______________________________________________________________________________
STREET CITY ZIP CODE

Age: _______ Date of Birth: __________________________

Applicant’s USBC Membership # ______________ E-Mail Address: ________________________

USE ADDITIONAL SHEET OF PAPER IF NECESSARY

1. Are you currently enrolled for the current semester or the up-coming semester? __________

If yes, provide name of school: ______________________________________________________

2. What courses/classes are you taking?___________________________________________

_______________________________________________________________________________

3. What changed in your life that made you decide you needed additional education?_________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

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4. How do you hope this education will affect your life? _________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Signature: ___________________________________ Dated: _________________________

INCOMPLETE AND/OR UNSIGNED APPLICATIONS WILL BE DISQUALIFIED

COMPLETED APPLICATION MUST BE POSTMARKED BY APRIL 15 AND SENT TO:
MICHELE SAVINI, SCHOLARSHIP CHAIRPERSON
STATEN ISLAND USBC ASSOCIATION
58 BERRY AVENUE
STATEN ISLAND, NY 10312