Scholarship Application Form

Msgr. Ronald C. Bill Scholarship Application

Application Deadline - March 1
Please use this application for the Monsignor Ronald C. Bill Scholarship Fund, Inc. (Sacred Heart Church in Cicero, New York, Divine Mercy in Central Square, New York and Immaculate Conception in Fayetteville, NY). You must be a confirmed member of the parish to be considered for this scholarship. You will need to upload a copy of your Confirmation certificate. This scholarship is open to all high school seniors (GPA 85 or above) who will be attending an accredited college (2 or 4 year) or an accredited trade school.
Read and Understand the instructions.*

Yes, I have read and understand the instructions
If selected, you may be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. Personal Data:

Tell us about yourself
Applicant Name:*

First NameMiddle NameLast NameSuffix
Parents Names:*
Home No. :*
Mobile No. :
E-mail :*
Where the confirmation will be send to
Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Confirmation Information:*
Confirmation Church Name
Confirmation Church Address
MonthDayYear
Confirmation Date
Upload a File
Confirmation Certificate Cancelof
First Communion Certificate

Upload a File

Cancelof
Baptismal Certificate

Upload a File

Cancelof
II. High School Information:
Presently a student at:*
Anticipated Graduation Date:*
Most recent cumulative GPA:*
Unofficial Transcript from High School required to be sent with this application including the telephone number of the Registrar.

Please attach an electronic version of your transcript. Transcript must have GPA listed.
Registrar Office Phone:*
Transcript*

Upload a File

Cancelof
I give permission to the Scholarship Chairperson to call my school to verify the transcript.
III. Employment Information:
Are you currently employed?*

YesNo
Currently Employed

Full-TimePart-Time
Employer:
Position:
IV. Church Activities
List any church activities.

Church Activities

	Name of Activity	Date	Notes (if needed)
1
2
3
4
5

V. Awards and Honors
List any significant awards and honors which you have received to include school, sports, music, arts.

Honors & Academic Awards

	Name of Award or Honor	Date	Grade Received (Fr, So, Jr, Sr)
1
2
3
4
5

Athletic and/or School Awards

	Name of Award or Honor	Date	Grade Received (Fr, So, Jr, Sr)
1
2
3
4
5

List extracurricular activities and volunteer service (beyond Confirmation Hours) including any leadership positions held and activities from church, school and community.

Extracurricular Activities

	Activity	Hours per week	Grade (Fr, So, Jr, Sr)/Dates
1
2
3
4
5

Volunteer Service

	Name of Company/Organization	Hours per week	Grade (Fr, So, Jr, Sr)/Dates
1
2
3
4
5

VI. Personal Statement
IT IS VERY IMPORTANT THAT APPLICANTS FOLLOW THE EXACT INSTRUCTIONS WHEN COMPLETING THE PERSONAL STATEMENT.

Please provide a concise and well-written statement (approximately 300 words). It can be less. Personal statements more that 300 words will be eliminated. The statement should be a concise description of the student's intended course of study and future career goals. The student should not include activities, awards, volunteer service & personal achievements which are to be included elsewhere on the application. Do not use your family name or your name within the document.
Personal Statement:*

0/300
VII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Should be Empty:

Msgr. Ronald C. Bill Scholarship Application

I. Personal Data:

II. High School Information:

III. Employment Information:

IV. Church Activities

V. Awards and Honors

VI. Personal Statement

VII. Applicant's E-Signature