Student Application Form

Janet Lebkuchner Scholarship

Applications must be postmarked no later than April 1

Name ________________________________________Student I.D. #_________________________

Address_______________________________ City____________________ State_____ Zip_______

Telephone________________________________ email_____________________________________

1.  Have you completed your first year at CCRI?  Yes ___ No ___

2.  Are you continuing your studies at CCRI?  Yes ___ No ___

3.  What is your G.P.A.?  _______

4.  Have you attached a one-page essay about your interest in theatre or costuming, and how you plan to use the
     scholarship?  Yes ___ No ___

I grant my permission to the Scholarship Review Committee to review my academic standing with CCRI’s Office of Enrollment Services, to review my financial need with CCRI’s Financial Aid Office, and to use my name and photo for publicity purposes. 


______________________
Student Signature/Date

Important Note: Scholarship recipient is required to write a thank you note (memo and sample thank you note) to the scholarship donor, and provide a brief biography (printable bio form) about themselves and their education/career goals and return both to:  Geraldine Peixoto, CCRI Foundation, Flanagan Campus, 1762 Louisquisset Pike, Lincoln, RI  02865. Please contact the CCRI Foundation if you need assistance in completing this responsibility at 333-7150 or e-mail at foundation@ccri.edu.