Student Application Form
Liberty Mutual Business Scholarship
Instructions: Please print clearly or type. Return completed form to:
Liberty Mutual Business Scholarshipc/o Business Administration Department Chair
Community College of Rhode Island
1762 Louisquisset Pike
Lincoln, RI 02865
Applications must be hand delivered by 4 p.m. or postmarked no later than April 1.
Name________________________________________ Student I.D. #_____________________
Address_________________________________ City________________ State____ Zip_______
Telephone__________________________________ email_______________________________
1. Are you continuing your education at CCRI? Yes__ No__
2. Are you enrolled in the Business Administration Department at CCRI? Yes__ No__
3. List community activities/services you have been involved in (use a separate sheet as necessary).
4. Have you applied for other CCRI scholarships, funds or awards? Yes___ No___
If yes, please list:
I grant my permission to the Scholarship Review Committee to review my academic standing with CCRI’s Office of Admissions and Records, to review my financial need with CCRI’s Financial Aid Office, and to use my name and photo for publicity purposes. I understand that all scholarship committee decisions are final.
___________________________________________
Student Signature/Date
______________________________
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.
