Application for Full Tuition
St. Basil Endowment Scholarships
in honor or Jim Cozzens
for
St. Michael 2025-2026 School Year
Student Name
*
First Name
Last Name
Parent 1 Name
*
First Name
Last Name
Parent 2 Name
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Grade entering for the 2025-2026 School Year:
*
Member of St. Basil Parish since:
*
Please list the school activities you participate in.
*
Please list other activities in which you participate.
*
Upload a two minute video explaining “What St. Michael School Means to Me.”
*
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Photograph/Media Permission and Ownership. I consent and grant permission for the Parish, Diocese, and affiliated parishes and/or their agents to photograph, audio record, video or otherwise record my minor child’s name, image, likeness, spoken words, in any form (the “Recordings”), and to use, display, publish, distribute, or alter the Recordings, or any part thereof, for any lawful purpose including, without limitation, on social media accounts, websites, in marketing publications, public relations and communications materials and/or presentations, and any other uses as may not be contemplated herein, without further notice or compensation. I further agree that the Recordings shall constitute the sole property of the Parish, Diocese, or affiliated parish taking the Recording.
Signature
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