Name:                                                                                
Address:                                                                                              

Telephone:                                          

Member's Name:                                                                     

Father's Name:                                                                       

Address:                                                                                              

Job Title and Place of Employment:                                                              

Mother's Name:                                                            

Address:                                                                                                 

Job Title and place of Employment:                                                            

Number of Dependent children and ages:                                            

School you will be attending:                                                                   

Address:                                                                                                 

Annual total cost:                               

Field of study:                                                                                          

Address:                                                                                                  

Please enclose the following:
1. Photo copy of last report card and school transcript.
2. Two character references written by non-family.
3. 50 to 100 word paragraph about yourself, hobbies, clubs, future ambitions...

Application for scholarship must be postmarked by March 1st, 2017.
Recipient (s) will be notified in April, 2016

This is a second semester scholarship. The money will be mailed to your school
on confirmation from the school that you are returning, and in good standing.

Please mail to: Southern Maine Sno-Goers   Attention. Scholarship Committee
       P.O. Box 1083, Sanford, Maine 04073                       
Justin Harvey Memorial Scholarship