MEGHAN P. BIRDSALL MEMORIAL SCHOLARSHIP
APPLICATION FORM

Please print out, then type or print your personal information in the appropriate spaces.
Or follow this format, if you prefer to use your computer to prepare your application.

 

Student's Full Name ____________________________________________ Date of Birth ____________
Home Address ________________________________________________________________________
Telephone ________________________________ Email ______________________________________
School  ______________________________________________________________________________
Name of Father
or Guardian _________________________________ Name of Mother ___________________________
Occupation _________________________________ Occupation _______________________________
Business Name _____________________________  Business Name ___________________________
Business Address ___________________________  Business Address _________________________
___________________________________________ _________________________________________
College you are planning to attend  ____________________________________________________
Address  _____________________________________________________________________________
_____________________________________________________________________________________
Major  _______________________________________________________________________________
Estimated Cost:   Annual Tuition $ ___________   Room/Board $ ___________   Total $ ____________
List your Extracurricular/Co-curricular School Activities / Clubs / Organizations
Name of Organization / Club / Activity                     Length of Time       Position
________________________________________ ________________ ___________________________
________________________________________ ________________ ___________________________
________________________________________ ________________ ___________________________
________________________________________ ________________ ___________________________
List Any Community Service You Have Performed During the Last Four Years
Specific Type of Service                                                                     Length of Time
______________________________________________________ _____________________________
______________________________________________________ _____________________________
______________________________________________________ _____________________________
______________________________________________________ _____________________________
References (Names of People Who Can Verify the Information Listed on the Application
Names                                                                                              Telephone Number
______________________________________________________ ______________________________
______________________________________________________ ______________________________
______________________________________________________ ______________________________
______________________________________________________ ______________________________
List Any High School Sports in Which You Have Participated
Sport                                                                                              Position Played
____________________________________________________ ________________________________
____________________________________________________ ________________________________
____________________________________________________ ________________________________
____________________________________________________ ________________________________
List Any Special Awards, Honors, Achievements, or Recognitions You Have Received Either in School or Within the Community
Award                                                                    Given By                                      Year Received
________________________________________ ____________________________ _______________
________________________________________ ____________________________ _______________
________________________________________ ____________________________ _______________
________________________________________ ____________________________ _______________
Outside Employment Record
Name of Company                                                   Type of Business                      Dates Employed
________________________________________ ____________________________ _______________
________________________________________ ____________________________ _______________
________________________________________ ____________________________ _______________
________________________________________ ____________________________ _______________
List Brother/Sister     Age   Living Home College                    Year Graduated    Occupation
________________  ____  qYes q No ________________ _____________ _____________________
________________  ____  qYes q No ________________ _____________ _____________________
________________  ____  qYes q No ________________ _____________ _____________________
________________  ____  qYes q No ________________ _____________ _____________________
School Grade Record - Please Attach a Copy of Your High School Transcript (Include Any Teacher or Mentor Recommendations)
Statement of Financial Need
The purpose of this statement is to offer you an opportunity to provide the scholarship committee with specific and relevant information that would enhance your claim for financial aid. The Meghan P. Birdsall Scholarship is need-based. It is important that a financial need exists. Please provide, and document, your family's income including page one of your family's Income Tax Return. Clearly explain any other issues that will make it difficult for you to meet your financial obligations for college. Please type your statement on a separate sheet.
Essay Question
Please answer the following question in 300 words or less. Type your essay on a separate sheet.        In today's society what single issue concerns you the most, and what meaningful contribution will you make?
Please Attach a Photograph of Yourself

Please do not staple. Affix with glue stick or two-sided tape. Recipient's picture will appear on the website; www.megbird.org

Signature of Applicant  _____________________________________________________________
Signature of Parent/Guardian  _______________________________________________________
Date   _________________
SUBMIT YOUR APPLICATION TO THE GUIDANCE DEPARTMENT AT WEST ESSEX HIGH SCHOOL BY APRIL 15TH