Our Chapter NO LONGER gives this Award 	
					
Directions to Applicants:
1. Type or print answers to all questions.
2. Your scholastic record should be submitted by your guidance counselor.
3. Submit one letter of recommendation from a classroom teacher.
4. Submit an essay on how you have prepared for college, what you expect to gain 
   from the college experience and what you hope to contribute to society.
5. Deadline for the application is April 15th 2024.
6. Mail to: Lorraine Astemborski, 1115 Mohegan Rd., Schenectady NY 12309 
7. Any questions call Lorraine at: 393-5688 
 
   Name:   
Address:   
   City:     Zip:  
Date of Birth:    Telephone: 
I will graduate from which high school: 
Schenectady
Scotia/Glenville
Niskayuna
Duanesburg
Mohonasen
Burnt Hills-Ballston Lake
Schalmont
Notre Dame/Bishop Gibbons
Mekeel Christian Academy
   
Attended from: To:   
List any extra-curricular school activities have you been active in during your four 
years of high school (List offices you have held.).  Use extra sheet if necessary.:
  
List the community activities have you participated in.  Use extra sheet if necessary.:
     
Signature of applicant _____________________________________     Date: