GEORGE BURLEW SCHOLARSHIP FUND

GRADUATE STUDENT APPLICATION FORM

1. Name ______

Last First Middle

2. Home Address______

______

3. Telephone Numbers (land line) ______

(cell) ______

4. E-mail Address______

5. Are you currently employed? (circle) YES NO

If “YES,” list company/organization, address and telephone number

______

______

6. What other scholarships have you applied for? ______

______

______

7.  What other scholarships have you accepted? ______

______

(OVER)

8.  Activities you have been involved with (school/community) ______

______

______

9.  Awards received to date ______

______

______

10. What Field of Study are you pursuing? ______

______

______

11. What organizations are you affiliated with? ______

______

Please submit your resume, letter of recommendation, proof of student status, and an essay on why you have chosen marine related studies, your future goals, and how this relates to the betterment of sportfishing.

Application Submission Date Deadlines: Spring Scholarship - March 15

Fall Scholarship - September 15

Mail completed applications to: Manasquan River Marlin & Tuna Club

PO Box 0251

Brielle, NJ 08730

______

Signature Date

MANASQUAN RIVER MARLIN AND TUNA CLUB

PO BOX 0251 - BRIELLE, NJ - 08730