Alison Mae Regan Memorial Fund
*Scholarship Application Form*
Fill out form completely, copy & paste or print & scan. Send electronic file to: www.alimaefund@alimaefund.com
PERSONAL INFORMATION
First Name Middle Initial Last Name
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School(s) attending/attended:
Name Address(es) Advisor Years
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Name Address
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What jobs have you held? List in order of employment with contact's name and phone number.
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Father’s Name |
Father’s Address |
Father’s Telephone |
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Mother’s Name |
Mother’s Address |
Mother’s Telephone |
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Father’s Occupation |
Father’s Annual Salary |
Mother’s Occupation |
Mother’s Annual Salary |
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How did you hear about the Alison Mae Regan Memorial Fund?
Newspaper Magazine Book School Advisor Family Member Internet Other
If Internet, please indicate web site address (url).
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In 250 words or less, print very clearly, an essay entitled “Why I Deserve This Scholarship and How My
College Education Will Help Me Make A Positive Impact On
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PRIVACY ACT STATEMENT
Under the authority of Article 5 U. S. C301, Information Act, your name, address, and your telephone number may be requested. This information is requested for the purpose of keeping the records of all applicants, forwarding names to other available funds and for AMRMF promotional purposes. Any individual who does not sign this privacy statement will be excluded from possible lists that may be sent to other scholarship funds and other AMRMF activities.
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