Student Application Form

Liberty Mutual Business Scholarship

Instructions: Please print clearly or type. Return completed form to:

Liberty Mutual Business Scholarship
c/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.