Walter & Eileen J. Jachna Scholarship
c/o Lela Morgan, Vice President Academic Affairs
Community College of Rhode Island
400 East Avenue
Warwick, RI  02886-1807

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.  In what program are you currently enrolled (check one):

Paralegal Studies Program ___   
Nursing Program ___
Developmental Disabilities Certificate Program ___

2.  How many credit hours are you currently enrolled?  _____

3.  How many credit hours have you completed? ____

4.  What is your current G.P.A.?  _____

5.  Are you a US citizen? Yes__ No__

or if Naturalized, when?  _____

6.  Describe your involvement in school and/or community activities?  (Attach additional pages as necessary.)
(If not, please provide reason as for the extenuating circumstances on a separate sheet of paper)  

7.  Describe your financial need. (Attach additional pages as necessary.) 

8. Please attach a 300-400 word essay describing your career goals and why you are committed to this career. 

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.