Italian American Police Society of New Jersey

Scholarship Application (This form may be completed on-screen and then printed and mailed)

Students: Please note that deadline for completed applications is .

Applicant: 1. Full Name: _____________________________________________________ 2. Home Address:__________________________________________________ 3. Phone & email______________________ _______________________ 4. Date of Birth:____________ 5. Social Security Number:_____________ 6. Name and Address of High School:____________________________________

________________________________________________________________ 7. Class Rank & Number of Students in Class:______________ 8. Highest SAT Score:__________________ Parents: 9. Parents Names:______________________ __________________________

10.Employers: Mother:’s _____________________________________________

Father’s _____________________________________________ 11. Name and ages of all the children in your family, the schools they are attending, tuition

charges, and, any scholarships they are receiving including amounts of said scholarships.

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12. List the names and addresses of colleges to which you have applied or intend

to apply with notations as to any acceptances you have received. Please note

estimated cost of tuition and room and board if applicable. _______________________

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May 1st, 2014

Reset the Application

13. To what degree will your four-year college education lead?

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14. Have you selected a major? If so, what?

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15. While attending college, where will you live? (check one)

At Home On Campus Off Campus but not Home

16. List all high schools and grammar schools you have attended, include address

of school and dates attended.

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17. List and describe any and all honors, prizes, and or awards, which you have

won to date, include monetary amounts if applicable.

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18. List any and all sources of financing your education, which are available,

including but not limited to, parental contributions, personal savings, scholarships, and/or

student loans. ___________________________________________________________

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19. Describe your work activities for the past three years, either for your family at

home or outside employers, or both, noting earnings if applicable.

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20. Specify your high school activities, detailing your participation and time spent

on each. ________________________________________________________________

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21. What are your favorite leisure time activities?________________________________

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22. If there are any special reasons why you feel you should win the scholarship, or

information, which you feel may assist the selection committee, please

indicate here. If you need additional space, please feel free to use a separate

piece of paper. ___________________________________________________________

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23. Please attach the following to this application; 1. PSAT or SAT results. 2. Most recent grade transcript showing all high school grades to date. 3. Any letters of acceptance received along with the estimated cost for attending the institution. 4. A copy of your parent's income tax statement for the year . 5. A signed statement describing yourself and your future personal, academic and career plans. I hereby certify that the foregoing information is true to the best of my knowledge. I under-stand that any willful misrepresentation of any fact can and will disqualify me from consid-eration. I understand that the deadline for submitting my completed application is . The Scholarship Brunch is scheduled for Sunday, at 10 AM at the Fiesta in Woodridge Signature of Applicant_______________________________________________

Signature of Parent ________________________________________________

Please Return Completed Application with attachments (prior to deadline) to:

Jerry Onnembo 499 Sussex Rd.

Wood Ridge, NJ 07075

May 1st, 2014June 1st, 2013

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