Scholarship Application

Club Madeirense S. S. Sacramento Charitable Foundation, Inc. 88 Tinkham St., New Bedford, MA 02746 Telephone (508) 992-6911 Fax (508) 992-5382 Email: correspondence@clubesss.org

If unable to attach or upload documents please mail them or email them to clubesss.scholarship@comcast.net

  • This application must contain accurate and detailed information and MUST be accompanied by an official transcript, including your most recent class rank and S.A.T. scores.
  • Please enclose one letter of recommendation from your guidance counselor or teacher of a major subject.
  • Eligibility:
    Graduating senior seeking an undergraduate or associate degree from an accredited college or university.
    Graduating senior seeking a certificate of completion from an accredited trade school.
  • Each question or request for information must be answered accurately and completely only in the space provided.
    Failure to do so will result in disqualification.
  • Scholarships of $1000.00 to each selected winner will be awarded upon completion of
Scholarship You Are Applying(Required)

APPLICANT’S INFORMATION

Name(Required)
Address(Required)
Date of Birth(Required)

FAMILY INFORMATION

Address(Required)
Address(Required)
Single brothers and sisters living at home under 18 years of age or still in school and are parent’s dependant (under 25)
Name
Age
School
 
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EDUCATION / COSTS

Your College choices(Required)
College Name
Estimated first year cost
Have you been accepted?
 
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REFERENCES

List three (3) references who have known you and your parents for at least three years. Exclude relatives:

IF CLAIMING TO BE A RELATIVE OF AN ACTIVE CLUB MEMBER, complete below, otherwise leave blank

Address of active member. If deceased, give last known address
Clear Signature

EXTRA CURRICULAR ACTIVITIES

List extra curricular activities you are or have been involved in.(Required)
click the "+" to add more (Max of 4)

EMPLOYMENT

List your past three employers
mark NA if not applicable
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mark NA if not applicable
mark NA if not applicable
mark NA if not applicable
mark NA if not applicable
mark NA if not applicable
mark NA if not applicable
mark NA if not applicable
mark NA if not applicable
mark NA if not applicable
mark NA if not applicable

ABOUT YOUR PLANS

Limit your answers to the following questions in the space provided.

DOCUMENTS

Please upload documents such as: Transcript, Recommendation Letter, Scholastic Record, include SAT scores if necessary
Drop files here or
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 20 MB, Max. files: 8.
    Transcript, Recommendation Letter, Scholastic Record, include SAT scores if necessary

    AFFIDAVIT

    I hereby authorize the Club Madeirense S. S. Sacramento, Inc. Scholarship Committee to review information pertinent to their decision on my application with my school guidance counselor.
    Clear Signature
    MM slash DD slash YYYY
    Clear Signature
    MM slash DD slash YYYY

    Deadline – Must be received no later than April 1st at letterhead address

    Club Madeirense S. S. Sacramento Charitable Foundation, Inc
    88 Tinkham St. New Bedford, MA 02746
    Telephone (508) 992-6911 Fax (508) 992-5382
    Email: clubesss.scholarship@comcast.net

    IMPORTANT!!!

    Selection of winners by the Club Madeirense S. S. Sacramento’s Scholarship Committee will be final.

    >>>>> WINNERS (from 3 categories) will be awarded $1,000 each upon completion of their first semester of college <<<<<

    Failure to complete this application accurately will be reason for disqualification.

    MAILING ADDRESS

    Clube Madeirense S. S. Sacramento, Inc.
    Scholarship Committee
    88 Tinkham St.
    New Bedford, MA 02746

    Revised January 2015