NEW YORK STATE RIGHT TO LIFE
COMMITTEE, INC.
EDUCATION
TRUST
APPLICATION
FOR SCHOLARSHIP GRANT
To be completed by Applicant:
Applicant's Name: ______________________________________
Address: ______________________________________
______________________________________
city state zip
Phone: (____)_________________
Attending High School: _____________________________ Phone (___)_______
Address:______________________________________________________________
Graduation Date:________________
Description of Right to Life Activities
during past four years (use additional pages if
necessary):__________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I have been accepted at, and plan to
attend this next year:
_________________________________________
(name of advanced education school)
Signature: __________________________
Date: __________________________
To be completed by parents:
Parents Income (check one):
Under
$35,000 _______
Over $35,000
per year _______
Number of
dependents _______
To be
completed by High School Official (Principal, Guidance Counselor, Teacher,
etc.)
EVALUATION
OF RIGHT TO LIFE WORK BY STUDENT:
1) Organizational
ability:
2) Attitudes:
3) Effectiveness:
(Note: It is not
necessary that the above be completed to obtain a scholarship award, but it
will be helpful in the determination of an award.)
To be completed by the local affiliated Right To Life
Committee:
Name of Group:
Address:
President/Chairman:
Evaluation of work by applicant
(include verification where possible):
Signed by:
(Official of local affiliated RTL group)
NAME:
ADDRESS:
PHONE:
(____)______________________
TITLE:
__________________________
(Applicant need not be a member of any Right to Life group,
but must be recommended and approved by a local affiliated Right to Life
Committee.)
RETURN THIS APPLICATION TO:
NEW YORK STATE RIGHT TO LIFE COMMITTEE
EDUCATIONAL TRUST
41 State Street, Suite M100
Albany, New York 12207