Student Application Form
Carosi / SkillsUSA Scholarship
Instructions: Please Print Clearly or Type and return completed
form to:
Mr. Joshua Klemp
SkillsUSA
CCRI
400 East Avenue
Warwick, RI 02886
Application must be postmarked no later than March 16.
Name _________________________________Student I.D. #_________________________
Address __________________________City ________________State
_______Zip________
Telephone
_________________________e-mail____________________________________
1. Are you entering CCRI or have you completed one year at CCRI? Yes__ No__
2. Are you in one of the following programs of study?
Allied Health Yes__ No__
Business Administration Yes__ No__
Computer Studies Yes__ No__
Engineering & Technology Yes__ No__
General Programs Yes__ No__
Industrial Technology Yes__ No__
Nursing Yes__ No__
Administration office Technology Yes__ No__
3. Have you been involved in a student run organization? Yes__ No__
Name of student run organization_________________________________
4. What is your G.P.A.? __________
5. Please (on a separate sheet) submit an essay on why you should receive this scholarship. Include information on your leadership skills.
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
Student Recipient must agree to continue/become a member of SkillsUSA at CCRI.
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.
