THE LENA M. & PETER I. KOROTIE

SCHOLARSHIP FUND

This fund was established at the Main Street Community Foundation in 1997 by former Bristol residents Peter and Lena Korotie. Born and raised in Bristol, they spent their 50 plus years of marriage pursuing the values of home, family and hard work. This scholarship emanated from their growing desire to do something special to help children in Bristol.

ELIGIBILITY

This scholarship is open to students from Bristol attending or planning to attend St. Paul Catholic High School in Bristol, CT.

QUALIFICATIONS

  1. Students must show evidence of academic achievement, service to school and community and financial need.
  2. Preference will be given to students who show special interest in the area of math and/or science.

PROCEDURE

1.  Fill out every section of the application.

2.  Attach a current report card.

3.  Attach a letter of recommendation from either a math or science teacher or the school principal explaining what you have shown them in terms of effort/desire in the area of math and science.

4.  Send or drop off two copies of your applications to:

Jarre Betts, Vice President of Programs

Main Street Community Foundation

120 Halcyon Drive

P.O. Box 2702

Bristol, CT 06011-2702

Application Deadline: March 16, 2018 at 4 p.m.

ID #______

2018 APPLICATION FORM (for office use only)

COVER SHEET

SUBMIT ONE SIGNED COPY OF THIS COVER SHEET

Instructions: To complete this form, click on the gray areas to type or print it and hand write it. Please call the Foundation office at 860.583.6363 if you have any questions.

THE LENA M. & PETER I. KOROTIE SCHOLARSHIP FUND

Applicant Information:

Name:
Tel. No.:
Home Address:
Email address:
Date of Birth:
What school are you attending now?

Family Information:

Father’s Full Name*:
Employer and Occupation:
Gross Annual Income:
*If deceased please list date:
Mother’s Full Name*:
Employer and Occupation:
Gross Annual Income:
*If deceased please list date:
If you have any siblings, list their ages and where they are employed or in school. Do not name:

List any special circumstances that the Committee should be aware of. This can include anything to explain unusual financial circumstances (loss or uncertainty of employment, medical bills not covered by insurance, death in the family, support to extended family, loss of child support, etc.):


School and Community Activities Information:

Please list the last four years. If more space is needed, attach an additional sheet in the same format listed below. Do not attach resume.

School Activities – Include all school related activities. This can include band, athletics, student government, professional associations, etc.

School Activity / Year(s) / Hours per week / Weeks Per Year / Leadership positions/award

Community Activities – This can include volunteer service, religious activities, scouts, etc.

Community Activity / Year(s) / Hours per week / Weeks Per Year / Leadership positions/award

I understand that misrepresentation of facts on this application is cause for denial of scholarship consideration, and that any scholarship assistance received under such circumstances must be immediately payable by the recipient to the Main Street Community Foundation. I also understand that if I do not complete this application in entirety and sign the application, I will not be considered for a scholarship award.

Signature______

Applicant Parent/Guardian (if applicant is under 18)

Date______Date______