Instructions and Application
The Cellini Charitable Foundation, Inc. will once again award a graduate/professional scholarship award. The amount of the award is $1000 and will be presented on a competitive basis, that is, chosen by academic standing
school semester.
is submitted.
Joseph Sciame
Vice President for Community Relations
St. John’s University
8000 Utopia Parkway
Jamaica, NY 11439
Graduate Scholarship Application
FOR JUNE 2013 GRADUATING COLLEGE SENIORS
FOR GRADUATE/PROFESSIONAL SCHOOLS APPLICATION MUST BE FILED NO LATER THAN May 10, 2013 NAME:
__________________________________
(Last) (First) (Middle)
ADDRESS:
____________________________________
(Street) (City) (State) (Zip)
PHONE________________E-MAIL_____________
DATE TO BE GRADUATED COLLEGE: _____________
CHECK ONE: ____MEMBER ____CHILD OF MEMBER
COLLEGE/UNIVERSITY YOU PLAN TO ATTEND: ____________
MAJOR AREA OF STUDY OR SUBJECT YOU WILL PURSUE: ________
I, the student, do hereby authorize the release of school records and consent to the review thereof by the Scholarship Committee of Cellini Lodge. I also agree to a final review of my transcript after graduation.
DATE________ APPLICANT’S SIGNATURE_________________________
Information regarding the member of Lodge or Parent of Applicant
NAME: ___________________________________________
(Last) (First) (Middle)
MONTH & YEAR INITIATED INTO CELLINI LODGE #2206: ____________
PROGRAMS or COMMITTEE INVOLVEMENT BY PARENT (If applicable)
IF TRANSFERRED FROM ANOTHER LODGE, MONTH & YEAR INITIATED INTO OSIA: ________
My son/daughter acknowledges and understands all of the above.
HOME PHONE #: _____________________
SIGNATURE OF PARENT ______________________________________