WEBSITE

Alpha Chi Rho Educational Foundation, Inc.

232 Highfield Lane
Nutley, New Jersey 07110
Ruth G. Bedford (973) 667-0249
Manager Fax (973) 667-2703

APPLICATION FOR UNDERGRADUATE SCHOLARSHIPS

DEADLINE ARIL 30th

Check one or more: Paul K Addams Award - $4,000.00

James McFadden Award - $2,000.00
John C. Enk Award - $2,000.00
Richard V. Olson Award - $3,000.00
Donald F. Jones - $2,000.00

Name _________________________________________________________________________________________
Last First Middle

Home Address: _________________________________________________________________________________

Number and Street City, State and zip
____________________________________ ____________________________________
Telephone Number E-Mail Address

College Address: ________________________________________________________________________________

Number and Street City, State and zip
____________________________________ ____________________________________
Telephone Number AXP Chapter

Date of birth _______________________________________ Citizen of: _________________________________

Colleges/Universities Dates of
Attended Attendance

Request the college(s) to send direct or attach transcript including last completed semester.
Attached College will send

Anticipated Graduation Date ________________________________

Degree: __________________________________ Major: ____________________________________

Plans After Graduation:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Reference letter from faculty member, administrator, chapter Advisor or employer:

Attached Reference will send

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List activities in which you have participated – student government, clubs, fraternities, publications, etc.:

Activity Years participated Offices held Honors/Awards

List the sport(s) in which you have participated:

Sport Years participated Honors/Awards

List community activities in which you have participated without pay:

Kind of work Name of agency or organization Years participated Special awards

List jobs you have held in the past three or four years:

Job and kind of work Employer Check Approximate Approximate

Summer School Dates Hours per week

Other pertinent information:

*ATTACH a one-page essay on a subject of your choice: yourself, goals, experiences of any kind, etc.

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FINANCIAL INFORMATION

Itemize below:

ASSETS: bank accounts, car, computer, etc.

LIABILITIES: prior loans, credit card balances, etc.

ANTICIPATED INCOME: scholarships, loans, jobs, family, etc.

EXPENSES: tuition, room, board, fees, books, supplies, equipment, transportation, commuting costs, etc.

If your EXPENSES are more than your INCOME, explain under COMMENTS how you expect to make up the
difference.

ASSETS Amount LIABILITIES Amount

ANTICIPATED INCOME EXPENSES

Source Amount Item Amount

Comments:

Date: ___________________________________ Signature: ________________________________________________