Due Thursday, March 29, 2018 to Ms. Franklin, SHS Post Secondary Counselor
The $4,000 Anton Segal Memorial Scholarship Application 2018
Sponsored by Hungry's Café
The Anton Segal Scholarship is designed to promote and celebrate multiculturalism and the
brotherhood of humankind.
Please note that unlike most other scholarships, this award is exclusively available to juniors!
Name ______
Phone #______
Address______Zip Code______
Email address ______
What are you planning to do after high school?
What are you planning to be doing in 10 years?
Please carefully read the companion 2018 Criteria for The Anton Segal Scholarship. The $4,000 award will be heavily based on your written essay. Please turn in three (3) copies of your application and essay.
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College Major Interest:
Extracurricular Activities at Stratford
Years participating
Fr. So. Jr.
Leadership position, if any
1.
2.
3.
4.
Activities outside of Stratford HS
(Service organizations, club sports, church, Scouts, etc.)
Years participating
Fr. So. Jr
Leadership position, if any
1.
2.
3.
4.
Work Experience
(Employer name and position)
Begin date
Month Year
End date
Month Year
Hours per
week
1.
2.
3.
4.
Community Service
(Specific activities/events you have done for the community through other groups or independently)
Years participating
Fr. So. Jr.
Total Hours(for all years you have participated in this activity)
1.
2.
3.
4.
Scholarships applied for:
Application pending
(please checkif your application
is still pending)
Amount received
1.
2.
3.
4.
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FAMILY INFORMATION
Total Family Income:
_____ Below $20,000 _____ $20,000-$50,000 _____ $50,000-$75,000 _____ Above $75,000
Names & Ages of Siblings:
Number of siblings currently enrolled in college or university:
Mother's Employer:
Father's Employer:
Transcript: A transcript is required for your application. Please request an unofficial transcript from Mr. Rutland and attach it to your completed application. The transcript does not need to be in a sealed envelope.
Teacher recommendations: Please put your name on the attached recommendation forms and give the recommendation forms to two teachers. These forms will be completed and returned directly to Ms. Franklin. Please attach to your application, a list naming the two teachers you gave the forms to – in case we need to contact those teachers to collect the forms.
**** Checklist ****
•Complete Application (3 pages).
•Complete essay and attach to your application.
•Request unofficial transcript from Mr. Rutland and attach to your application.
•Make three (3) copies of your completed application package.
•Give teacher recommendation forms to two teachers - to be returned directly to Ms. Franklin.
•Please attach a list of the names of the teachers that you gave recommendation forms. Only one copy of this list is needed.
•Turn in three (3) copies of your completed application package (application, essay and transcript) to Ms. Franklin in room 224 by Friday, March 31, 2017.
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