Student Application Form
Christin M. Liston Scholarship
Instructions: Please Print Clearly or Type and return completed form to:
Christina M. Liston Scholarship
Committee
c/o
Margaret Connell, English Department
CCRI Liston Campus
One Hilton Street
Providence, RI 02905
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 a graduating student? Yes__ No__
2. Have you achieved a minimum grade point average of 3.5? Yes__ No__
3. Have you attended the Liston Campus? Yes__ No__
4.
Have you been accepted at a four-year institution
for continued studies toward a bachelor’s degree in
business,
computer science, or a related field? Yes__
No__
5. List the extracurricular activities in which you participated while you attended CCRI and describe your role and responsibilities in each. (Attach additional pages as necessary.)
6. Provide examples of your personal initiative and/or leadership qualities when you were at CCRI. (Attach additional pages as necessary.)
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.
____________________________________
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.
