CSCU Foundation Scholarship Form

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Which Scholarship(s) are you applying for?

James Frost ScholarshipT. Clark Hull Public Service ScholarshipTed Martocchio ScholarshipPratt and Whitney Science and Technology ScholarshipThe Tulisano Humanitarian Award ScholarshipDonofrio Family Science ScholarshipDonofrio Public Media Scholarship and Internship Program

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Area CodePhone Number

Community College*

Intended College/University*

Intended Major*

Ted Martocchio Scholarship Requirement*

I am the child of a member of the CT State Building and Trades Union

GPA*

PERSONAL STATEMENT:*

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Please attach to this application a 1-2 page typed, personal statement giving a brief history of your background, achievements, volunteer or public service activities, career goals, your financial need for the scholarship and how it will make a difference in your studies, any other information relevant to being selected for this scholarship.

REFERENCES:*

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Please include two letters of reference with your application and include their names and phone numbers. One must be from an academic area and the second attesting to community/high school involvement.

Media Release*

I understand that as a scholarship recipient my name and image may be used to promote the Connecticut State Colleges and Universities Foundation scholarships as part of its publicity activities. I understand that publicity activities may include, but are not limited to, digital media, news articles, announcements, websites and video. By accepting a scholarship, I consent to having my likeness, voice, name, community and profile in print, and to the use of photographs and/or recordings for promotional activities for the Connecticut State Colleges and Universities Foundation.

Electronic Signature*

CSCU Foundation Scholarships

View Scholarship Eligibility Requirements