Student Application Form

Bobby Hackett Jazz Scholarship

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

CCRI Foundation's Bobby Hackett Jazz Scholarship Committee
c/o Music Department Chair
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. Are you enrolled in CCRI's Fine Arts Program? Yes__ No__

2. Are you a music major? Yes__ No__

3. Are you enrolled in Jazz Studies? Yes__ No__

4. Have you completed six (6) credits of study in music? Yes__ No__

5. What are your educational/career goals? (Attach additional pages as necessary.)

6. Why should you be selected as the Bobby Hackett Jazz Scholarship recipient?
(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.